Johnny  H  Lott  Jr  OD
Contract Details
Facility name
Provider ID
P000005727
NPI
1962736660
Tax ID
421273174
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
1616 Beltline Rd Southwest
Decatur, AL 35601
United States
County
Morgan
Phone
2563559645 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address