Provider Demographics
NPI:1891782223
Name:HANNIGAN, JAMES R (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:HANNIGAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14370 W. HWY. 29
Mailing Address - Street 2:SUITE 8
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642
Mailing Address - Country:US
Mailing Address - Phone:512-515-5100
Mailing Address - Fax:512-515-0500
Practice Address - Street 1:14370 W. HWY. 29
Practice Address - Street 2:SUITE 8
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642
Practice Address - Country:US
Practice Address - Phone:512-515-5100
Practice Address - Fax:512-515-0500
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2370TG152W00000X, 152WC0802X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1180713-05Medicaid
TX8E0487Medicare ID - Type UnspecifiedINDIVIDUAL-GROUP #00726Y
TXT93165Medicare UPIN