Healthcare Provider Details

I. General information

NPI: 1376508549
Provider Name (Legal Business Name): MARK JAMES CINALLI OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 DIVISION ST
PARKERSBURG WV
26101-5619
US

IV. Provider business mailing address

229 PLANTATION DR
MINERAL WELLS WV
26150-9638
US

V. Phone/Fax

Practice location:
  • Phone: 304-485-7485
  • Fax: 304-485-5410
Mailing address:
  • Phone: 304-489-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberWV759OD
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: