Jose Alfredo    Payan    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004919
NPI
1609009885
Tax ID
010693831
Effective Date
4/1/2012
Last Updated
10/22/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
9740 Barker Cypress Road Suite 112
Cypress, TX 77433
United States
County
Harris
Phone
2815507900 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address