Ann    Cherian    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004665
NPI
1487818258
Tax ID
262952148
Effective Date
4/1/2012
Last Updated
10/25/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
6000 Highway 6
Missouri City, TX 77459
United States
County
Fort Bend
Phone
2812088180 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address