Active NPI
Larry E Malicky, OD FAAO
- Optometrist
- Columbus, NE
National Provider Identifier
1295748903
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 801
- Practice address
- 566 S Quail LN
Columbus, NE 68601-6308 - Phone
- (402) 561-0545
- Fax
- (402) 564-0078
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 801 | NE | Primary |
Addresses
Primary practice location
566 S Quail LN
Columbus, NE 68601-6308
Mailing address
566 S Quail Lane
Columbus, NE 68601-6308
Phone (402) 908-4787
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 47055862700 | Medicaid | NE | |
| N001920 | Other | NE | CHAMPUS |
| 06731 | Other | NE | BC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 801 | NE | MD | Hearing Instrument Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eyecare Associates of Columbus PC | Optometrist | Past | Accepting new patients |
| Eyecare Associates of Columbus PC | Optometrist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Columbus, NE
- NPI 1972671881
-
- Optometrist
- Schuyler, NE
- NPI 1992865356
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1225411200000",
"number": "1295748903",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "566 S QUAIL LANE",
"city": "COLUMBUS",
"state": "NE",
"postal_code": "686016308",
"telephone_number": "402-908-4787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "566 S QUAIL LN",
"city": "COLUMBUS",
"state": "NE",
"postal_code": "686016308",
"telephone_number": "402-561-0545",
"fax_number": "402-564-0078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALICKY",
"first_name": "LARRY",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "OD FAAO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-14",
"last_updated": "2008-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NE",
"license": "801",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "47055862700",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CHAMPUS",
"identifier": "N001920",
"state": "NE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "06731",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbus, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.