Provider Demographics
NPI:1942404843
Name:JOSEPH M. MALEE OD SC
Entity Type:Organization
Organization Name:JOSEPH M. MALEE OD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MALEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-424-6540
Mailing Address - Street 1:4647 W 103RD ST
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4779
Mailing Address - Country:US
Mailing Address - Phone:798-424-6540
Mailing Address - Fax:708-424-7554
Practice Address - Street 1:4647 W 103RD ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4779
Practice Address - Country:US
Practice Address - Phone:798-424-6540
Practice Address - Fax:708-424-7554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0553610001Medicare NSC