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Individual

MARK KORTHALS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
13195 WEAVER LAKE RD, MAPLE GROVE, MN 55369-9410
(763) 420-5112
(763) 420-6957
Mailing address
13195 WEAVER LAKE RD, MAPLE GROVE, MN 55369-9410
(763) 420-5112
(763) 420-6957

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2972
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
151668000
MN
Enumeration date
12/20/2006
Last updated
09/04/2015
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