Contract Details
Ancillary Care Services
Facility name
Advanced Eye Care
Provider ID
P000003832
NPI
1114028883
Tax ID
731649911
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
1721 Knickerbocker Road
San Angelo, TX 76904
United States
County
Tom Green
Phone
3259448531 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address