Healthcare Provider Details

I. General information

NPI: 1295661288
Provider Name (Legal Business Name): MALIK MOHAMMED JAYBER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25102 BROOKPARK RD
NORTH OLMSTED OH
44070-6414
US

IV. Provider business mailing address

2211 JOHNSTONE WAY
WESTLAKE OH
44145-2913
US

V. Phone/Fax

Practice location:
  • Phone: 440-875-5542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.007497
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: