| Doctor Name: | MR. PETER MALY |
| NPI Number: | 1780727743 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | R.D.O. |
| License Number: | 04MA1011 |
| Business Practice Address: | 109-6 Masonic Home Road Charlton, MA - 01507 |
| Business Phone Number: | 5082481188 |
| Business Fax Number: | 5082485128 |
| Mailing Address: | Po Box 194, CHARLTON |
| State: | MA |
| Postal Code: | 015070194 |
| Phone Number: | 5082481188 |
| Fax Number: | 5082485128 |
| NPI Enumeration Date: | 02/15/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FC0800X |
| License Number: | 04MA1011 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | MA |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Contact Lens |
| Taxonomy Definition: | An optician or other ancillary support staff person who, where authorized by state law and trained or certified to do so, may fit or dispense contact lenses to a patient based on the prescription of an optometrist or medical physician. |