Coly Brett    Marsh    OD
Contract Details
Facility name
Provider ID
P000005586
NPI
1902852346
Tax ID
752711435
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
7638 Stonebrook Pkwy
Frisco, TX 75034
United States
County
Denton
Phone
9727121010 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address