Provider Demographics
NPI:1790268431
Name:MALONE, DELIA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:DELIA
Middle Name:MARIE
Last Name:MALONE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 W 18TH ST STE 311
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616-5132
Mailing Address - Country:US
Mailing Address - Phone:312-929-3340
Mailing Address - Fax:
Practice Address - Street 1:329 W 18TH ST STE 311
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-5132
Practice Address - Country:US
Practice Address - Phone:312-929-3340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046.011606152W00000X
IN18004125152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152W00000XEye and Vision Services ProvidersOptometrist