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Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005585
NPI
1902837586
Tax ID
203693323
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
1930 Country Place Parkway Suite 102
Pearland, TX 77584
United States
County
Brazoria
Phone
7134366464 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address