Provider Demographics
NPI:1396732731
Name:LIBERTY HILL EYE ASSOCIATES, LLC
Entity type:Organization
Organization Name:LIBERTY HILL EYE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPEUTIC OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:HANNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:512-515-5100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1725269-01Medicaid
TX1725269-01Medicaid