Individual
DR. LARRY E MALICKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD FAAO
Contact information
Practice address
566 S QUAIL LN, COLUMBUS, NE 68601-6308
(402) 561-0545
(402) 564-0078
Mailing address
566 S QUAIL LANE, COLUMBUS, NE 68601-6308
(402) 908-4787
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
801
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
06731
BC
NE
05
—
47055862700
—
NE
01
—
N001920
CHAMPUS
NE
Enumeration date
08/14/2006
Last updated
10/31/2008
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