Healthcare Provider Details

I. General information

NPI: 1780727743
Provider Name (Legal Business Name): PETER MALY R.D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109-6 MASONIC HOME ROAD
CHARLTON MA
01507
US

IV. Provider business mailing address

PO BOX 194
CHARLTON MA
01507-0194
US

V. Phone/Fax

Practice location:
  • Phone: 508-248-1188
  • Fax: 508-248-5128
Mailing address:
  • Phone: 508-248-1188
  • Fax: 508-248-5128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number04MA1011
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code156FC0801X
TaxonomyContact Lens Fitter
License Number04MA1011
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberMA4511
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: