MEDICARE: MARK ALEXANDER CIMINI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC5844	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OPC5844	OTHER	FL	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740889385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ALEXANDER CIMINI

Provider Business Mailing Address
First Line	:	185 SW 7TH ST APT 2805
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33130-2978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1097 S LE JEUNE RD
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-2639
Country	:	US
Telephone Number	:	305-442-2020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2020
Last Update Date	:	10/25/2020

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