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General NPI Number Information
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NPI Number | 1407281009
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Entity Type | Organization
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Legal Business Name | MALIK EYE INSTITUTE LLC
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Dates
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Enumeration Date | 09/13/2013
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Last Update Date | 09/13/2013
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Provider Practice Location Address
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Address Line | 3865 N MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61114-5603
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Country | US
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Telephone | 815-399-2190
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Fax | 815-399-5543
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Provider Business Mailing Address
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Address Line | 3865 N MULFORD RD
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City | ROCKFORD
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State | IL
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Zip | 61114-5603
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Country | US
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Telephone | 815-399-2190
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Fax | 815-399-5543
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Authorized Official
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Title or Position | PHYSICIAN AND OWNER
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Name | DR. MASUD I MALIK
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Credential | M.D.
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Telephone | 815-399-2190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 036-110588
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License Number State | IL
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