MEDICARE: DR. MARIO JOSEPH CONTALDI O.D.

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	152WC0802X	Corneal and Contact Management Optometrist	03329TG	TX
2	152W00000X	Optometrist	03329TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10132262	OTHER	TX	ACCOUNTABLE
2	752952111	OTHER	TX	SUPERIOR
3	752952111	OTHER	TX	PHCS
4	2200067	OTHER	TX	UNITED HEALTH CARE
5	752952111	OTHER	TX	VISION SERVICE PLAN
6	3733154	OTHER	TX	CIGNA
7	752952111	OTHER	TX	GREAT WEST
8	115953	OTHER	TX	EYEMED
9	82361E	OTHER	TX	BLUE CROSS BLUE SHIELD
10	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
11	2150370	OTHER	TX	FIRST HEALTH
12	752952111	OTHER	TX	TRICARE
13	752952111	OTHER	TX	VISION CARE PLAN
14	752952111	OTHER	TX	CHOICE CARE/ HUMANA
15	752952111	OTHER	TX	UNICARE
16	5434359	OTHER	TX	AETNA
17	752952111	OTHER	TX	HEALTH SMART
18	752952111	OTHER	TX	TX TRUE CHOICE
19	P3375750	OTHER	TX	OXFORD UNITED HEALTH CARE

General Provider Information

NPI Number	:	1215043765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO JOSEPH CONTALDI O.D.

Provider Business Mailing Address
First Line	:	111 E 4TH ST STE 440
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6241
Country	:	US
Telephone Number	:	618-462-9818
Fax Number	:	314-741-4947

Provider Business Practice Location Address
First Line	:	7728 MID CITIES BLVD
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76180-4621
Country	:	US
Telephone Number	:	817-281-3386
Fax Number	:	817-281-9287

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

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	08/18/2022

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