DR. MARK T MCDERMOTT (NPI# 1083680599) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083680599 |
| Entity Type | Individual |
| Full Name | DR. MARK T MCDERMOTT |
| Credential | OD |
| Practice Address |
2353 Rice St Ste 206 Roseville MN 55113 |
| Mailing Address |
2353 Rice St Ste. 206 Roseville MN 55113-3739 |
| Practice Telephone | 6514838148 |
| Practice Fax Number | 6514833206 |
| Mailing Telephone | 6514838148 |
| Mailing Fax Number | 6514833206 |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2008-05-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | 02169 | IA | Eye and Vision Services Providers |
| Y | 152W00000X | Optometrist | 2594 | MN | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MN | 152713400 | 05 | |
| MN | MEDICA | 22 07646 | 01 |
| MN | BLUE CROSS BLUE SHIELD | 57D32MC | 01 |
| MN | METROPOLITAN HEALTH PLAN | 615152747 | 01 |
| MN | U CARE | 124899 | 01 |
| MN | HEALTH PARTNERS | 26613 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528513132 | Mark Mcdermott | Physical Therapist | 60 Main St Ste 1, Hamburg, NY 14075-4905 | 2016-08-24 |
| 1326085820 | Mark Leo Mcdermott | Ophthalmology | Kresge Eye Institute, 4717 St Antoine, Detroit, MI 48201 | 2006-06-01 |
| Street Address |
2353 RICE ST STE 206 |
| City | ROSEVILLE |
| State | MN |
| Zip Code | 55113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396083978 | Trusted Healthcare Services, Inc | Home Health | 2353 Rice St, Suite 105, Roseville, MN 55113-3739 | 2013-01-16 |
| 1477807998 | Choice Medical Supply Mn | Durable Medical Equipment & Medical Supplies | 2353 Rice St, Suite 105, Roseville, MN 55113-3739 | 2012-11-06 |
| 1174836050 | Homecare Services Plus Inc | In Home Supportive Care | 2353 Rice St, Ste 104, Roseville, MN 55113-3739 | 2010-07-20 |
| 1861699852 | Joan Rosalie Arbour | Chiropractor | 2353 Rice St, Suite 210, Roseville, MN 55113-3739 | 2007-07-02 |
| 1457568768 | Urban Chiropractic | Chiropractor | 2353 Rice St, Suite 225, Roseville, MN 55113-3739 | 2007-05-17 |
| 1700811486 | Julie Ann Childs | Counselor | 2353 Rice St, Suite 214, Roseville, MN 55113-3739 | 2006-07-11 |
| 1942253653 | Saint Anthony Optical Ltd. | Optometrist | 2353 Rice St, Ste. 206, Roseville, MN 55113-3739 | 2006-05-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396384376 | Zachary Mattson | Physician Assistant | Regus Coworking Space 2355 Highway 36 West, Suite 400, Office #427, Roseville, MN 55113 | 2019-12-23 |
| 1467010330 | Ahmed Issa | Student in an Organized Health Care Education/Training Program | 1550 Larpenteur Ave W, Apt 235, St Paul, MN 55113 | 2019-06-05 |
| 1821653833 | Suite Living Senior Care of Little Canada | Assisted Living Facility | 2740 Rice Street, Little Canada, MN 55113 | 2019-05-06 |
| 1902370505 | Diverse Assessments and Treatment, LLC | Psychologist | 1935 Cty Rd B2 W Ste 270, Roseville, MN 55113 | 2019-01-16 |
| 1588138473 | Applewood Home Health Care, LLC | Home Health | 2021 E Hennepin Avenue # 402-1, Minneapolis, MN 55113 | 2019-01-14 |
| 1699251520 | Optum Infusion Services 500, Inc. | Durable Medical Equipment & Medical Supplies | 2685 Patton Rd, Roseville, MN 55113 | 2018-07-13 |
| 1083104145 | Suite Living Senior Care of Roseville | Assisted Living Facility | 197 County Road B2 W, Roseville, MN 55113 | 2018-05-15 |
| 1477055796 | Sunrise Residential Services LLC | Home Health | 216 Maple Ln, Roseville, MN 55113 | 2018-03-02 |
| 1194223024 | Alissa Hoff | Specialist | 1595 Mn 36 - 584 10 Rosedale Center, Roseville, MN 55113 | 2018-01-25 |
| 1841705118 | Kingsland Care Services Incorporated | Case Management | 2301 Rice Street, Suite 101, Roseville, MN 55113 | 2017-12-08 |
| Find all providers in zip 55113 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629622543 | Alyssa Akimi Matsuo | Optometrist | 9221 Sierra College Blvd Ste 130, Roseville, CA 95661-5919 | 2019-07-29 |
| 1558828483 | Thrive Eyes LLC | Optometrist | 100 S Harding Blvd Ste 100, Roseville, CA 95678-3360 | 2019-02-27 |
| 1407332182 | Camille Weissenberg | Optometrist | 1422 Blue Oaks Blvd Ste 150, Roseville, CA 95747-5196 | 2018-07-16 |
| 1699275735 | Shahrokh Khoshsohbat | Optometrist | 2100 Snelling Ave N Ste 39, Roseville, MN 55113-6030 | 2018-02-15 |
| 1609393305 | Liana Bambi Switzer | Optometrist | 1010 Pleasant Grove Blvd Ste 120, Roseville, CA 95678-6118 | 2017-08-24 |
| 1396190864 | Alicia Marie Johnson | Optometrist | 32443 Gratiot Ave, Roseville, MI 48066-1154 | 2016-05-03 |
| 1093147910 | Jennifer J. Everett Optometry, P.C. | Optometrist | 10271 Fairway Dr Ste 100, Roseville, CA 95678-3542 | 2013-08-01 |
| 1609117035 | Jennifer J Everett | Optometrist | 10271 Fairway Dr, Suite 100, Roseville, CA 95678-3540 | 2013-03-11 |
| 1861756454 | Carmen Perez Moreno | Optometrist | 1125 Galleria Blvd, Roseville, CA 95678-1935 | 2012-06-27 |
| 1275848202 | Macarius, Max & Daniel | Optometrist | 1128 Galleria Blvd, Roseville, CA 95678-1992 | 2010-08-14 |
| Find all providers in ROSEVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.