Provider Demographics
NPI:1720635220
Name:KARL MINZENMAYER
Entity Type:Organization
Organization Name:KARL MINZENMAYER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:MINZENMAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-391-2000
Mailing Address - Street 1:358 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1713
Mailing Address - Country:US
Mailing Address - Phone:719-391-2000
Mailing Address - Fax:
Practice Address - Street 1:358 MAIN ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1713
Practice Address - Country:US
Practice Address - Phone:719-391-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty