Contract Details
Facility name
Northside Family Eye Care
Provider ID
P000004833
NPI
1568500916
Tax ID
760623974
Effective Date
5/24/2012
Last Updated
10/23/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
68.00
Location Details
Address
3305 Orlando St
Houston, TX 77093
United States
County
Harris
Phone
7137425244 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address