Ronald David    Medlock    OD
Contract Details
Medical West Hueytown Health Center
Facility name
Provider ID
P000001138
NPI
1730271701
Tax ID
631143538
Effective Date
11/20/2007
Last Updated
4/7/2012
Direct Contract
Yes
Status
Active
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
3004 Allison Bonnett Memorial Dr
Hueytown, AL 35023
United States
County
Jefferson
Phone
2054913299 (Phone)
Billing Details
Address
Billing Phone
2054817121
Specialty Type
Optometry
Map
Address