Healthcare Provider Details

I. General information

NPI: 1457686586
Provider Name (Legal Business Name): DAVID RYAN LALLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 MAIN ST STE 201
SPRINGFIELD MA
01107-1145
US

IV. Provider business mailing address

3640 MAIN ST STE 201
SPRINGFIELD MA
01107-1139
US

V. Phone/Fax

Practice location:
  • Phone: 413-732-2333
  • Fax: 413-732-8065
Mailing address:
  • Phone: 413-732-2333
  • Fax: 413-732-8065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number254315
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: