Provider Demographics
NPI:1770749566
Name:INGRID HILLIARD PLLC
Entity type:Organization
Organization Name:INGRID HILLIARD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-997-2627
Mailing Address - Street 1:3240 E. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581
Mailing Address - Country:US
Mailing Address - Phone:281-997-2627
Mailing Address - Fax:281-485-8329
Practice Address - Street 1:3240 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-4502
Practice Address - Country:US
Practice Address - Phone:281-997-2627
Practice Address - Fax:281-485-8329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-01
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4985T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00703896OtherRAILROAD MEDICARE
TXP00703896OtherRAILROAD MEDICARE
TXU50907Medicare UPIN