Provider Demographics
NPI:1134172430
Name:JOHN C. KORTENBER OPTOMETRY PC
Entity type:Organization
Organization Name:JOHN C. KORTENBER OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:KORTENBER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-395-3937
Mailing Address - Street 1:112 N THORINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ALGONA
Mailing Address - State:IA
Mailing Address - Zip Code:50511-2614
Mailing Address - Country:US
Mailing Address - Phone:515-395-3937
Mailing Address - Fax:515-395-3938
Practice Address - Street 1:112 N THORINGTON ST
Practice Address - Street 2:
Practice Address - City:ALGONA
Practice Address - State:IA
Practice Address - Zip Code:50511-2614
Practice Address - Country:US
Practice Address - Phone:515-395-3937
Practice Address - Fax:515-395-3938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02341152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAMK1211010OtherDEA
IAMK1211010OtherDEA
IA6207320001Medicare NSC