Mark Korthals, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

2972 Issued in MN

Practice address

13195 Weaver Lake Rd
Maple Grove, MN 55369-9410

Phone

(763) 420-5112

Fax

(763) 420-6957

NPI assigned

Dec 20, 2006

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

Other identifiers 1

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

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Hutchinson Superstore IncGroup PAC ID 6901835636, 4 clinicians

Minnesota Optical LLCGroup PAC ID 1557528841, 5 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Hutchinson Superstore Inc

  • Eyewear Supplier
  • Hutchinson, MN
  • NPI 1225127756

  Optometrist

  Medicare reassignment Care Compare group NPD
• Minnesota Optical LLC

  • Optometrist
  • Elk River, MN
  • NPI 1831303437
  Medicare reassignment Care Compare group NPD
• Hutchinson Superstore Inc

  • Optometrist
  • Delano, MN
  • NPI 1851921951
  NPD
• Hutchinson Superstore Inc.

  • Eyewear Supplier
  • Litchfield, MN
  • NPI 1841389384
  NPD
• Minnesota Optical LLC

  • Eyewear Supplier
  • Edina, MN
  • NPI 1962829580
  NPD
• Red Wing Vision Care LLC

  • Optometrist
  • Red Wing, MN
  • NPI 1326251711
  NPD (past)
• Vision World Inc

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

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

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

{
    "created_epoch": "1166572800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441324800000",
    "number": "1215091749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13195 WEAVER LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553699410",
            "telephone_number": "763-420-5112",
            "fax_number": "763-420-6957"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13195 WEAVER LAKE RD",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553699410",
            "telephone_number": "763-420-5112",
            "fax_number": "763-420-6957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORTHALS",
        "first_name": "MARK",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-20",
        "last_updated": "2015-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "2972",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151668000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew John Kollath
• Patricia Ann Koning, DDS
• Ibolya Konkoly, DC
• Andrea Konz
• Heidi Kopacek, PSYD, LP
• Bridget Kosak, PA-C
• David M. Kosfeld, LMFT
• Kelsey Kostreba, PA-C
• Nora Caroline Kotlowski
• Lawrence Joseph Kotok, DDS

• Optometrist in Maple Grove, MN
• Providers in Maple Grove, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2015; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.