Beverly    Newhouse    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004682
NPI
1497836779
Tax ID
562288867
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
192 Gulf Freeway Suite C-2
League City, TX 77573
United States
County
Galveston
Phone
2815547080 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address