Organization
CLEAR LAKE OPTICS CORP
Active
Other names
Michael L Korthals
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKE L KORTHALS (OWNER)
(641) 424-0780
Entity
Organization
Contact information
Practice address
422 S PIERCE AVE STE 100A, 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
—
DB8928
RAILROAD MEDICARE
IA
Enumeration date
09/05/2007
Last updated
12/14/2023
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