| Organization Name: | MALONEY'S CUSTOM OCULAR PROSTHETICS, INC. |
| NPI Number: | 1043360977 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KEVIN SCHOU (PRESIDENT) |
| Mailing Address: | 4035 Mercantile Dr Ste 208 Lake Oswego |
| State: | OR US |
| Postal Code: | 970352591 |
| Phone Number: | 5036751320 |
| Fax Number: | |
| NPI Enumeration Date: | 01/11/2007 |
| NPI Last Update Date: | 06/26/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1700X |
| License Number: | 2002801 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OR |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Ocularist |
| Taxonomy Definition: | |