Frank    Lee    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004702
NPI
1508856477
Tax ID
460486368
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
10201 Broadway Street Suite 101
Pearland, TX 77584
United States
County
Brazoria
Phone
7134363333 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address