Organization
MALIK EYE INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. RANAE D BERGMAN (MANAGER)
(815) 399-2190
Entity
Organization
Contact information
Practice address
4857 MANHATTAN DR, ROCKFORD, IL 61108-2265
(815) 399-0599
(815) 399-5543
Mailing address
4857 MANHATTAN DR, ROCKFORD, IL 61108-2265
(815) 399-0599
(815) 399-2499
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
036-110588
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6725940001
PTAN
IL
Enumeration date
11/27/2012
Last updated
09/06/2013
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