Provider Demographics
NPI:1215043765
Name:CONTALDI, MARIO JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:JOSEPH
Last Name:CONTALDI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:111 E 4TH ST STE 440
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-6241
Mailing Address - Country:US
Mailing Address - Phone:618-462-9818
Mailing Address - Fax:314-741-4947
Practice Address - Street 1:7728 MID CITIES BLVD
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-4621
Practice Address - Country:US
Practice Address - Phone:817-281-3386
Practice Address - Fax:817-281-9287
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03329TG152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10132262OtherACCOUNTABLE
TX752952111OtherSUPERIOR
TX752952111OtherPHCS
TX2200067OtherUNITED HEALTH CARE
TX752952111OtherVISION SERVICE PLAN
TX3733154OtherCIGNA
TX752952111OtherGREAT WEST
TX115953OtherEYEMED
TX82361EOtherBLUE CROSS BLUE SHIELD
TX191450902Medicaid
TX2150370OtherFIRST HEALTH
TX752952111OtherTRICARE
TX752952111OtherVISION CARE PLAN
TX752952111OtherCHOICE CARE/ HUMANA
TX752952111OtherUNICARE
TX5434359OtherAETNA
TX752952111OtherHEALTH SMART
TX752952111OtherTX TRUE CHOICE
TXP3375750OtherOXFORD UNITED HEALTH CARE
TX752952111OtherUNICARE
TX752952111OtherVISION CARE PLAN