J.R.    Lacey    OD
Contract Details
Ancillary Care Services
Facility name
Provider ID
P000006504
Tax ID
582413634
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
12700 Hill Country Galleria Boulevard
Bee Cave, TX 78738
United States
County
Travis
Phone
5122577070 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address