Romea Evanty    Harris-Baxter    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000004921
NPI
1609025188
Tax ID
262894978
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
11115 McCracken Circle Suite A
Cypress, TX 77429
United States
County
Harris
Phone
2814697610 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address