MEDICARE: MARK THOMAS MENTZER OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	01912	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184813305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK THOMAS MENTZER OD

Provider Business Mailing Address
First Line	:	2200 BLAIRSFERRY CROSSING
Second Line	:
City	:	HIAWATHA
State	:	IA
Zip	:	52233-7900
Country	:	US
Telephone Number	:	319-294-9546
Fax Number	:	319-395-0089

Provider Business Practice Location Address
First Line	:	2200 BLAIRSFERRY CROSSING
Second Line	:
City	:	HIAWATHA
State	:	IA
Zip	:	52233-7900
Country	:	US
Telephone Number	:	319-294-9546
Fax Number	:	319-395-0089

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2007
Last Update Date	:	06/15/2009

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