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General NPI Number Information
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NPI Number | 1386958064
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Entity Type | Individual
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Provider Name | CARLTON ROBERT FENZL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 03/18/2021
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Provider Practice Location Address
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Address Line | 777 TANGLEFOOT LN
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City | BETTENDORF
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State | IA
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Zip | 52722-1650
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Country | US
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Telephone | 563-323-2020
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Fax | 563-459-6615
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Provider Business Mailing Address
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Address Line | 777 TANGLEFOOT LN
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City | BETTENDORF
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State | IA
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Zip | 52722-1650
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Country | US
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Telephone | 563-323-2020
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Fax | 563-459-6615
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036.137712
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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License Number | 42474
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License Number State | IA
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Taxonomy #3
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Taxonomy Code | 207WX0120X
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Taxonomy Name | Cornea and External Diseases Specialist Physician
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License Number | 036.137712
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 42474
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License Number State | IA
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