MEDICARE: L BRADLEY LOCKHART MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	J5192	TX

General Provider Information

NPI Number	:	1073724571
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L BRADLEY LOCKHART MD PA

Provider Business Mailing Address
First Line	:	1912 W 35TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78703-1324
Country	:	US
Telephone Number	:	512-458-1922
Fax Number	:	512-458-8362

Provider Business Practice Location Address
First Line	:	2727 GRAMERCY ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-1617
Country	:	US
Telephone Number	:	713-799-9975
Fax Number	:	713-458-8362

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. L BRADLEY LOCKHART
Credential	:	M.D.
Telephone Number	:	512-458-1922

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	07/16/2007

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