Provider Demographics
NPI:1013061241
Name:MALIK, EDWARD JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOSEPH
Last Name:MALIK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11035 LAVENDER HILL DR STE 180
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2957
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
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV236152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV880329534OtherTAX ID