Provider Demographics
NPI:1225003783
Name:L BRADLEY LOCKHART MD PA
Entity Type:Organization
Organization Name:L BRADLEY LOCKHART MD PA
Other - Org Name:CHILDREN'S EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:L.
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:LOCKHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-458-1922
Mailing Address - Street 1:1912 W 35TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1324
Mailing Address - Country:US
Mailing Address - Phone:512-458-1922
Mailing Address - Fax:512-458-8362
Practice Address - Street 1:1912 W 35TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1324
Practice Address - Country:US
Practice Address - Phone:512-458-1922
Practice Address - Fax:512-458-8362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6885207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00T07UMedicare ID - Type UnspecifiedGROUP #
TX82Y651Medicare ID - Type UnspecifiedDR. LOCKHART'S IND. #
TXB24435Medicare UPIN