Contract Details
Ancillary Care Services
Facility name
Lakewood Eye Care
Provider ID
P000004929
NPI
1609189349
Tax ID
274402826
Effective Date
7/26/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
12918 Malcomson Road
Cypress, TX 77429
United States
County
Harris
Phone
7137327428 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address