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Dean
R
Ellis
MD
Contract Details
Alabama Eye Services Network
Facility name
Provider ID
P000000490
NPI
1942429659
Tax ID
630691977
Effective Date
3/1/1999
Last Updated
5/5/2014
Direct Contract
Yes
Term Date
12/3/2013
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
1805 Lakeside Circle
Auburn, AL 36830
United States
County
Lee
Phone
3348213838
(
Phone
)
Billing Details
Address
1805 Lakeside Circle
Auburn, AL 36830
Billing Phone
3348213838
Specialty Type
Ophthalmology
Map
Address