Korthals, Mark
Korthals, Mark is an individual health care provider with primary practice located at 13195 Weaver Lake Rd , Maple Grove MN 55369-9410. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Korthals, Mark can be contacted via phone (763) 420-5112.Contact Information
Primary practice address
13195 Weaver Lake Rd
Maple Grove MN 55369-9410
Phone: (763) 420-5112
Fax: (763) 420-6957
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2972 | Minnesota |
Profile Details
| NPI number | 1215091749 |
|---|---|
| LBN Legal business name | Korthals, Mark |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Dec 20th, 2006 |
| Last updated | Sep 4th, 2015 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1215091749 | NPPES |
| Minnesota | MEDICAID | 151668000 |
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