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