Provider Demographics
NPI:1285677013
Name:MARK J CINALLI OD FAAO PLLC
Entity Type:Organization
Organization Name:MARK J CINALLI OD FAAO PLLC
Other - Org Name:GILMER COUNTY EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:CINALLI
Authorized Official - Suffix:
Authorized Official - Credentials:OD, FAAO
Authorized Official - Phone:304-462-5366
Mailing Address - Street 1:307 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:GLENVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26351-1170
Mailing Address - Country:US
Mailing Address - Phone:304-462-5366
Mailing Address - Fax:
Practice Address - Street 1:307 HOWARD ST
Practice Address - Street 2:
Practice Address - City:GLENVILLE
Practice Address - State:WV
Practice Address - Zip Code:26351-1170
Practice Address - Country:US
Practice Address - Phone:304-462-5366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV759-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150790000Medicaid
WV0150790000Medicaid
5651510001Medicare NSC