Contract Details
Ancillary Care Services
Facility name
Westside Eye Care
Provider ID
P000004976
NPI
1629365291
Tax ID
452596846
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
1560 Eldridge Parkway Suite 136
Houston, TX 77077
United States
County
Harris
Phone
2815317020 (Phone)
Billing Details
Address
5429 LBJ Freeway
Suite 700
Dallas, TX 75240
Specialty Type
Optometry
Map
Address