Provider Demographics
NPI:1215950472
Name:INMAN, CYNTHIA DAWN (OD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:DAWN
Last Name:INMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:261 MERCER MALL RD
Mailing Address - Street 2:SUITE 802
Mailing Address - City:BLUEFIELD
Mailing Address - State:WV
Mailing Address - Zip Code:24701-9098
Mailing Address - Country:US
Mailing Address - Phone:304-327-0207
Mailing Address - Fax:304-324-0908
Practice Address - Street 1:530 W RIDGE RD
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-1188
Practice Address - Country:US
Practice Address - Phone:276-223-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV993-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVP00072518OtherUNITED HEALTHCARE
WV3102055 000Medicaid
VA010050651Medicaid
WV131471OtherUMWA
WVP00072518OtherUNITED HEALTHCARE
WVIN4063821Medicare ID - Type Unspecified