Easter  W  Tjandra    OD
Contract Details
Facility name
Provider ID
P000005214
NPI
1730161506
Tax ID
954893608
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
301 Coit Rd
Plano, TX 75075
United States
County
Collin
Phone
9726125959 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address