Provider Demographics
NPI:1053505008
Name:JOHN M.CLINE,O.D.,INC
Entity Type:Organization
Organization Name:JOHN M.CLINE,O.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:304-872-1400
Mailing Address - Street 1:200 WAL ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-2100
Mailing Address - Country:US
Mailing Address - Phone:304-872-1400
Mailing Address - Fax:304-872-1306
Practice Address - Street 1:200 WAL ST
Practice Address - Street 2:
Practice Address - City:SUMMERSVILLE
Practice Address - State:WV
Practice Address - Zip Code:26651-2100
Practice Address - Country:US
Practice Address - Phone:304-872-1400
Practice Address - Fax:304-872-1306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV810D152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149270000Medicaid
0595921Medicare UPIN
WV0595921Medicare PIN