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Bryan
I
Grissett
III
MD
Contract Details
Alabama Eye Services Network
Facility name
Provider ID
P000000659
NPI
1790716744
Tax ID
630858777
Effective Date
3/1/1999
Last Updated
5/5/2014
Direct Contract
Yes
Term Date
5/5/2014
Status
Contract Discounts
Discount Type
F
Fee Schedule Name
103.00
Fee Schedule Multiplier
Location Details
Address
429 South 3rd Street
Gadsden, AL 35901
United States
County
Etowah
Phone
2565478634
(
Phone
)
Billing Details
Address
P.O. Box 8567
Gadsden, AL 35902
Billing Phone
2565478634
Specialty Type
Ophthalmology
Map
Address