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Bertrand
M
Anz
II
MD
Contract Details
Alabama Eye Services Network
Facility name
Provider ID
P000000043
NPI
1598778912
Tax ID
630691977
Effective Date
3/1/1999
Last Updated
12/3/2013
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
121 North 20th Street Building 26
Opelika, AL 36801
United States
County
Lee
Phone
3347491486
(
Phone
)
Billing Details
Address
Specialty Type
Ophthalmology
Map
Address