Provider Demographics
NPI:1336393289
Name:LARRY E MALICKY OD PC
Entity Type:Organization
Organization Name:LARRY E MALICKY OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MALICKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD PC
Authorized Official - Phone:402-980-4787
Mailing Address - Street 1:566 S QUAIL LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-6308
Mailing Address - Country:US
Mailing Address - Phone:402-980-4787
Mailing Address - Fax:
Practice Address - Street 1:566 S QUAIL LN
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-6308
Practice Address - Country:US
Practice Address - Phone:402-980-4787
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE801152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty