Provider Demographics
NPI:1376508549
Name:CINALLI, MARK JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAMES
Last Name:CINALLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 PLANTATION DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL WELLS
Mailing Address - State:WV
Mailing Address - Zip Code:26150-9638
Mailing Address - Country:US
Mailing Address - Phone:304-489-2150
Mailing Address - Fax:
Practice Address - Street 1:416 DIVISION ST
Practice Address - Street 2:
Practice Address - City:PARKERSBURG
Practice Address - State:WV
Practice Address - Zip Code:26101-5619
Practice Address - Country:US
Practice Address - Phone:304-485-7485
Practice Address - Fax:304-485-5410
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV759OD152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0150790000Medicaid
WV0150790000Medicaid
WVC10545375Medicare ID - Type UnspecifiedMEDICARE DR. NUMBER