Provider Demographics
NPI:1578698205
Name:CLINE, JOHN MORGAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MORGAN
Last Name:CLINE
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 1:200 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
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV810-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149270000Medicaid
WV410032708OtherMEDICARE RAILROAD
WV43382OtherDAVIS INS
0149270000OtherUMWA
WV43382OtherDAVIS INS
WV43382OtherDAVIS INS
WV311542687Medicare UPIN