Mark    Welding    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005524
NPI
1881619021
Tax ID
261107116
Effective Date
4/1/2012
Last Updated
10/23/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2300 Highland Village Road Suite 200
Highland Village, TX 75077
United States
County
Denton
Phone
9723173888 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address