Provider Demographics
NPI:1194719765
Name:OMALLEY, RONAN EUGENE (MD)
Entity type:Individual
Prefix:
First Name:RONAN
Middle Name:EUGENE
Last Name:OMALLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:STE 750
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2761
Mailing Address - Country:US
Mailing Address - Phone:713-524-3434
Mailing Address - Fax:713-524-3220
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 750
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2727
Practice Address - Country:US
Practice Address - Phone:713-524-3434
Practice Address - Fax:713-524-3220
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF3267207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128348306Medicaid
TX128348306Medicaid
TX8301B6Medicare ID - Type Unspecified