Provider Demographics
NPI:1386634210
Name:MALARA, RICHARD CHRISTIAN (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CHRISTIAN
Last Name:MALARA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8395 OSWEGO RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-6801
Mailing Address - Country:US
Mailing Address - Phone:315-622-3500
Mailing Address - Fax:315-622-3522
Practice Address - Street 1:8395 OSWEGO RD
Practice Address - Street 2:KIMBROOK VILLAGE SQUARE
Practice Address - City:BALDWINSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13027-6801
Practice Address - Country:US
Practice Address - Phone:315-622-3500
Practice Address - Fax:315-622-3522
Is Sole Proprietor?:No
Enumeration Date:2005-10-22
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTU005325-1152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336346550OtherCORPORATE NPI
NY1386634210OtherINDIVIDUAL NPI
NY6181270001Medicare NSC
NY1336346550OtherCORPORATE NPI
NYU36953Medicare UPIN
NYBA0190Medicare PIN