Provider Demographics
NPI:1902906803
Name:MALIK EYE INSTITUTE, L.L.C.
Entity Type:Organization
Organization Name:MALIK EYE INSTITUTE, L.L.C.
Other - Org Name:MASUD MALIK, M.D.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYISICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASUD
Authorized Official - Middle Name:I
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-399-2190
Mailing Address - Street 1:3865 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5603
Mailing Address - Country:US
Mailing Address - Phone:815-399-2190
Mailing Address - Fax:815-399-5543
Practice Address - Street 1:3865 N. MULFORD RD.
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5603
Practice Address - Country:US
Practice Address - Phone:815-399-2190
Practice Address - Fax:815-399-5543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILH26338Medicare UPIN
IL214298Medicare PIN