A. Jeffrey    Sol    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005720
NPI
1962585109
Tax ID
421601034
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
401 North Highway 75
Denison, TX 75020
United States
County
Grayson
Phone
9034636000 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address