Mark T McDermott, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2594 Issued in MN

Practice address

4243 4TH Ave S
Minneapolis, MN 55409-2113

Phone

(612) 821-2003

Fax

(612) 821-2818

NPI assigned

Feb 24, 2006

Last updated

Jun 16, 2025By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Saint Anthony Optical LTD.

  dba saint anthony eyecare assoc.

  • Optometrist
  • Roseville, MN
  • NPI 1942253653
  NPD
• Southside Community Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Minneapolis, MN
  • NPI 1538137757
  NPD
• Southside Community Health Services, Inc.

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1679690952
  NPD
• Vision World Inc

  dba Vision World

  • Eyewear Supplier
  • Stillwater, MN
  • NPI 1740365642
  NPD (past)
• Vision World Inc

  dba Vision World

  • Eyewear Supplier
  • Fergus Falls, MN
  • NPI 1982789533
  NPD (past)
• Visionworks Inc

  dba Visionworks

  • Eyewear Supplier
  • Omaha, NE
  • NPI 1205924792
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750032000000",
    "number": "1083680599",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4243 4TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554092113",
            "telephone_number": "612-821-2003",
            "fax_number": "612-821-2818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4243 4TH AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554092113",
            "telephone_number": "612-821-2003",
            "fax_number": "612-821-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDERMOTT",
        "first_name": "MARK",
        "middle_name": "T",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-24",
        "last_updated": "2025-06-16",
        "certification_date": "2025-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "02169",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "22 07646",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U CARE",
            "identifier": "124899",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "METROPOLITAN HEALTH PLAN",
            "identifier": "615152747",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "152713400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "26613",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "57D32MC",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John Jeffrey McCullough, MD
• Kristen McCullough, CNM
• Sarah Lindsey McCullough, CNM, FNP-C
• Martha L McCusker, MD
• Debra Jean McDermott, RN, CNP
• Olive McDermott
• Virginia Anne McDermott, PH.D.
• Ashley McDew
• Cameron McDonald-Hyman, MD, PHD
• Autumn Renee McDonald, LGSW

• Optometrist in Minneapolis, MN
• Providers in Minneapolis, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.