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General NPI Number Information
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NPI Number | 1780727743
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Entity Type | Individual
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Provider Name | PETER MALY R.D.O.
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Gender | Male
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 109-6 MASONIC HOME ROAD
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City | CHARLTON
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State | MA
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Zip | 01507
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Country | US
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Telephone | 508-248-1188
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Fax | 508-248-5128
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Provider Business Mailing Address
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Address Line | PO BOX 194
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City | CHARLTON
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State | MA
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Zip | 01507-0194
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Country | US
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Telephone | 508-248-1188
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Fax | 508-248-5128
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FC0800X
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Taxonomy Name | Contact Lens Technician/Technologist
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License Number | 04MA1011
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 156FC0801X
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Taxonomy Name | Contact Lens Fitter
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License Number | 04MA1011
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | MA4511
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License Number State | MA
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