Provider Demographics
NPI:1326896283
Name:MALONEY, MEGHAN A (ABOC)
Entity type:Individual
Prefix:
First Name:MEGHAN
Middle Name:A
Last Name:MALONEY
Suffix:
Gender:F
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 HOUSTON HWY
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-4990
Mailing Address - Country:US
Mailing Address - Phone:361-827-7278
Mailing Address - Fax:361-582-4678
Practice Address - Street 1:4001 HOUSTON HWY
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4990
Practice Address - Country:US
Practice Address - Phone:361-827-7278
Practice Address - Fax:361-582-4678
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-07
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256992156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician