Healthcare Provider Details

I. General information

NPI: 1104107747
Provider Name (Legal Business Name): RYAN PARENT MALONE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25242 KINGSLAND BLVD
KATY TX
77494-3256
US

IV. Provider business mailing address

8614 WESTWOOD CENTER DR FL 9
VIENNA VA
22182-2442
US

V. Phone/Fax

Practice location:
  • Phone: 281-644-2010
  • Fax: 281-574-4600
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7775
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: