Provider Demographics
NPI:1144291642
Name:MALONEY, JOHN MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARTIN
Last Name:MALONEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 CHEROKEE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-3628
Mailing Address - Country:US
Mailing Address - Phone:254-295-6202
Mailing Address - Fax:254-773-5576
Practice Address - Street 1:1119 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-5214
Practice Address - Country:US
Practice Address - Phone:254-773-3248
Practice Address - Fax:254-773-5576
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3499T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093261803Medicaid
TX75-2307858OtherFED EMPLOYER ID #
TX75-2307858OtherFED EMPLOYER ID #