Contract Details
Ancillary Care Services
Facility name
M.D. Jackman, OD & Associates
Provider ID
P000004846
NPI
1568742682
Tax ID
452491671
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
1000 West 39th Street
Austin, TX 78756
United States
County
Travis
Phone
5123236996 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address