James    Anderson    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000005751
NPI
1972767713
Tax ID
742769904
Effective Date
4/1/2012
Last Updated
10/31/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
2921 Pat Booker Road Suite 112
Universal City, TX 78148
United States
County
Bexar
Phone
2106535665 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address