Mark Joseph Medley II, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2987 Issued in TN

Practice address

USA Meddac Fort Drum
11050 Mt. Belvedere Blvd.
Fort Drum, NY 13602

Phone

(315) 772-2778

NPI assigned

Jul 22, 2011

Last updated

Jul 25, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1311292800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1124306279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "USA MEDDAC FORT DRUM",
            "address_2": "11050 MT. BELVEDERE BLVD.",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "157-722-7783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "USA MEDDAC FORT DRUM",
            "address_2": "11050 MT. BELVEDERE BLVD.",
            "city": "FORT DRUM",
            "state": "NY",
            "postal_code": "13602",
            "telephone_number": "315-772-2778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLEY",
        "first_name": "MARK",
        "middle_name": "JOSEPH",
        "name_prefix": "Dr.",
        "name_suffix": "II",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-22",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "2987",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Benjamin McDaniels, DPT
• Megan Marie McGinty
• Deshawn McGowan
• Sarah Marie McSherry, DMD
• Rhiannon McWherter, MS OTR/L
• Rachel Anne Meirose, PA-C
• Christian James Meko, MD
• Megan Lu Melocoton, DMD
• Madeline Kay Merriam, DPT
• Lynette Mientus, MS, RDN

• Optometrist in Fort Drum, NY
• Providers in Fort Drum, NY by specialty
• Optometrist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.