Contract Details
Ancillary Care Services
Facility name
Westlake Eyecare
Provider ID
P000004821
NPI
1558593251
Tax ID
275442175
Effective Date
4/1/2012
Last Updated
10/28/2013
Direct Contract
No
Status
Active
Contract Discounts
Discount Type
S
State Fee Schedule Multiplier
76.00
Location Details
Address
4613 Bee Caves Road Suite 201
Austin, TX 78746
United States
County
Travis
Phone
5123470700 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address