MEDICARE: LIBERTY HILL EYE ASSOCIATES, LLC

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	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396732731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBERTY HILL EYE ASSOCIATES, LLC

Provider Business Mailing Address
First Line	:	14370 W. HWY. 29
Second Line	:	SUITE 8
City	:	LIBERTY HILL
State	:	TX
Zip	:	78642
Country	:	US
Telephone Number	:	512-515-5100
Fax Number	:	512-515-0500

Provider Business Practice Location Address
First Line	:	14370 W. HWY. 29
Second Line	:	SUITE 8
City	:	LIBERTY HILL
State	:	TX
Zip	:	78642
Country	:	US
Telephone Number	:	512-515-5100
Fax Number	:	512-515-0500

Authorized Official
Title or Position	:	OWNER/THERAPEUTIC OPTOMETRIST
Name	:	DR. JAMES R. HANNIGAN
Credential	:	O.D.
Telephone Number	:	512-515-5100

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	08/13/2008

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