Provider Demographics
NPI:1164663597
Name:EDWARD J MALIK OD CHARTERED AND ASSOCIATES
Entity Type:Organization
Organization Name:EDWARD J MALIK OD CHARTERED AND ASSOCIATES
Other - Org Name:EDWARD J MALIK, OD CHARTERED AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-254-0332
Mailing Address - Street 1:11035 LAVENDER HILL DRIVE
Mailing Address - Street 2:STE 180
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135
Mailing Address - Country:US
Mailing Address - Phone:702-254-0332
Mailing Address - Fax:702-685-4112
Practice Address - Street 1:11035 LAVENDER HILL DR STE 180
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89135-2957
Practice Address - Country:US
Practice Address - Phone:702-254-0332
Practice Address - Fax:702-685-4112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-16
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1013061241OtherCOMMERCIAL INSURANCE
NVT67123Medicare UPIN
NVBM883ZMedicare PIN