Individual
MICHAEL L KORTHALS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
422 S PIERCE AVE, MASON CITY, IA 50401-2709
(641) 424-0780
(641) 424-2345
Mailing address
422 S PIERCE AVE STE 100A, MASON CITY, IA 50401-2709
(641) 424-0780
(641) 424-2345
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
02146
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1204016
—
IA
01
—
35096
BLUE CROSS & BLUE SHIELD
IA
01
—
42149949950401
TRICARE
IA
01
—
5178720001
DMERC
IA
01
—
IA0101
JOHN DEERE
IA
01
—
P00135209
RR MEDICARE
IA
Enumeration date
07/10/2006
Last updated
12/14/2023
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