Provider Demographics
NPI:1588667869
Name:MALIK, RUSSELL (OD)
Entity Type:Individual
Prefix:DR
First Name:RUSSELL
Middle Name:
Last Name:MALIK
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 1:7640 BELLFORT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77061-1707
Mailing Address - Country:US
Mailing Address - Phone:713-645-3035
Mailing Address - Fax:713-645-6666
Practice Address - Street 1:7640 BELLFORT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77061-1707
Practice Address - Country:US
Practice Address - Phone:713-645-3035
Practice Address - Fax:713-645-6666
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4510T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093331901Medicaid
TX82981EMedicare ID - Type Unspecified
TX093331901Medicaid