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General NPI Number Information
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NPI Number | 1790729721
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Entity Type | Individual
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Provider Name | CHARLES J MALONE O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 2720 WATSON BLVD
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City | WARNER ROBINS
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State | GA
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Zip | 31093-8041
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Country | US
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Telephone | 478-971-4949
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Fax |
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Provider Business Mailing Address
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Address Line | 2720 WATSON BLVD
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City | WARNER ROBINS
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State | GA
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Zip | 31093-8041
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Country | US
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Telephone | 478-971-4949
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Fax |
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00513300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT003423
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License Number State | GA
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