Faris    Ohan    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005531
NPI
1881681542
Tax ID
261441826
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
2035 FM 359 Suite 11
Richmond, TX 77406
United States
County
Fort Bend
Phone
2812328257 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address