Contract Details
Facility name
Museum District TSO
Provider ID
P000005512
NPI
1871562256
Tax ID
760567936
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
4850 Main St
Houston, TX 77002
United States
County
Harris
Phone
7135235109 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address