Michael    Toups    OD
Contract Details
Eye Trends Affiliate
Facility name
Provider ID
P000005153
NPI
1700828308
Tax ID
760691388
Effective Date
4/1/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4333 Kingwood Dr
Kingwood, TX 77339
United States
County
Harris
Phone
2813603762 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address