Provider Demographics
NPI:1336346550
Name:RICHARD C. MALARA, OD PC
Entity Type:Organization
Organization Name:RICHARD C. MALARA, OD PC
Other - Org Name:MALARA EYECARE & EYEWEAR GALLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:MALARA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-622-3500
Mailing Address - Street 1:8395 OSWEGO RD
Mailing Address - Street 2:SUITE 7C
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-6801
Mailing Address - Country:US
Mailing Address - Phone:315-622-3500
Mailing Address - Fax:315-622-3522
Practice Address - Street 1:8395 OSWEGO RD
Practice Address - Street 2:SUITE 7C
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-6801
Practice Address - Country:US
Practice Address - Phone:315-622-3500
Practice Address - Fax:315-622-3522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005325152W00000X
NYTUV005325-1332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU36953Medicare UPIN
NYBA0190Medicare ID - Type Unspecified
NY6181270001Medicare NSC