Mini    John    OD
Contract Details
Southmore Texas State Optical
Facility name
Provider ID
P000006527
Tax ID
760257768
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
1250 Uvalde
Houston, TX 77015
United States
County
Harris
Phone
7139469300 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address