Provider Demographics
NPI:1013971266
Name:MALONEY, MICHAEL CASEY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CASEY
Last Name:MALONEY
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 1:1360 E VENICE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-9066
Mailing Address - Country:US
Mailing Address - Phone:941-488-2020
Mailing Address - Fax:941-484-2200
Practice Address - Street 1:2601 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-4504
Practice Address - Country:US
Practice Address - Phone:941-925-2020
Practice Address - Fax:941-330-2200
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3917152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00290581OtherRAILROAD MEDICARE
P00290581OtherRAILROAD MEDICARE
FLK0672Medicare ID - Type UnspecifiedMEDICARE GROUP
FLV04169Medicare UPIN
FLK0672AMedicare ID - Type UnspecifiedMEDICARE GROUP
FLU3993YMedicare ID - Type UnspecifiedMEDICARE PROVIDER