Shabana    Khan    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005381
NPI
1801003504
Tax ID
201006536
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
8880 State Highway 121 Suite 141
McKinney, TX 75070
United States
County
Collin
Phone
2143832047 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address