Michael    Toups    OD
Contract Details
Eye Trends Affiliate
Facility name
Provider ID
P000006530
Tax ID
760516293
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
1329 West Davis
Conroe, TX 77304
United States
County
Montgomery
Phone
9364413939 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address