Basic Information
| Provider Information | |||||||||
| NPI: | 1215043765 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONTALDI | ||||||||
| FirstName: | MARIO | ||||||||
| MiddleName: | JOSEPH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 E 4TH ST STE 440 | ||||||||
| Address2: | |||||||||
| City: | ALTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620026241 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184629818 | ||||||||
| FaxNumber: | 3147414947 | ||||||||
| Practice Location | |||||||||
| Address1: | 7728 MID CITIES BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTH RICHLAND HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761804621 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172813386 | ||||||||
| FaxNumber: | 8172819287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 08/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | 03329TG | TX | N | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management | 152W00000X | 03329TG | TX | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 10132262 | 01 | TX | ACCOUNTABLE | OTHER | 752952111 | 01 | TX | SUPERIOR | OTHER | 752952111 | 01 | TX | PHCS | OTHER | 2200067 | 01 | TX | UNITED HEALTH CARE | OTHER | 752952111 | 01 | TX | VISION SERVICE PLAN | OTHER | 3733154 | 01 | TX | CIGNA | OTHER | 752952111 | 01 | TX | GREAT WEST | OTHER | 115953 | 01 | TX | EYEMED | OTHER | 82361E | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 191450902 | 05 | TX | MEDICAID | 2150370 | 01 | TX | FIRST HEALTH | OTHER | 752952111 | 01 | TX | TRICARE | OTHER | 752952111 | 01 | TX | VISION CARE PLAN | OTHER | 752952111 | 01 | TX | CHOICE CARE/ HUMANA | OTHER | 752952111 | 01 | TX | UNICARE | OTHER | 5434359 | 01 | TX | AETNA | OTHER | 752952111 | 01 | TX | HEALTH SMART | OTHER | 752952111 | 01 | TX | TX TRUE CHOICE | OTHER | P3375750 | 01 | TX | OXFORD UNITED HEALTH CARE | OTHER |