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General NPI Number Information
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NPI Number | 1104788595
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Entity Type | Individual
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Provider Name | MALLORY MICHELLE RICKETT OD
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Gender | Female
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Dates
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Enumeration Date | 11/24/2025
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 655 TAYLOR ST
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City | FORT WORTH
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State | TX
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Zip | 76102-4821
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Country | US
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Telephone | 817-289-6825
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Fax |
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Provider Business Mailing Address
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Address Line | 23010 JANE RD
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City | TOMBALL
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State | TX
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Zip | 77377-3700
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 11387TG
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License Number State | TX
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