Active NPI
Greg B Markeson, OD
- Optometrist
- West St Paul, MN
National Provider Identifier
1205917473
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 2557
- Practice address
- 1750 Robert St S
West St Paul, MN 55118-3919 - Phone
- (651) 306-0412
- Fax
- (952) 487-1447
- NPI assigned
- Oct 17, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 2557 | MN | Primary |
Addresses
Primary practice location
1750 Robert St S
West St Paul, MN 55118-3919
Mailing address
1396 Chatterton Rd
Eagan, MN 55123-1480
Phone (612) 812-4691
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 020722500 | Medicaid | MN |
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fourone2020 PLLC | Optometrist | Current | Accepting new patients |
| Luxottica of America Inc | Past | Accepting new patients |
Locations
1750 Robert St S
West St Paul, MN 55118
Phone (651) 306-0412
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161043200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758585600000",
"number": "1205917473",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1396 CHATTERTON RD",
"city": "EAGAN",
"state": "MN",
"postal_code": "551231480",
"telephone_number": "612-812-4691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1750 ROBERT ST S",
"city": "WEST ST PAUL",
"state": "MN",
"postal_code": "551183919",
"telephone_number": "651-306-0412",
"fax_number": "952-487-1447"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARKESON",
"first_name": "GREG",
"middle_name": "B",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-17",
"last_updated": "2025-09-23",
"certification_date": "2025-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "2557",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "020722500",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in West St Paul, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 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.