Individual provider Active NPI

Mark F. Cook, O.D.

  • Optometrist
  • Johnson Creek, WI
National Provider Identifier
1407817752
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
2358-035 Issued in WI
Practice address
412 Highland Blvd
Johnson Creek, WI 53038-9504
Phone
(920) 390-9038
NPI assigned
Mar 28, 2006
Last updated
Jul 13, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 2358-035 WI Primary
Corneal and Contact Management Optometrist 152WC0802X 2358-035 WI

Addresses

Primary practice location

412 Highland Blvd
Johnson Creek, WI 53038-9504

Mailing address

412 Highland Blvd
Johnson Creek, WI 53038-9504

Other identifiers 1

IdentifierTypeStateIssuer
38724000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20040126000930 WI Practitioner - Optometry 1658273941 Reassigns benefits to 1 organization
Practice locations: Marshall, WI

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

14151 W National Ave
New Berlin, WI 53151-4528
Phone (414) 541-2100

2305 30TH Ave
Kenosha, WI 53144-1411
Phone (262) 597-2020

2505 N Mayfair Rd
Suite 100
Wauwatosa, WI 53226-1404
Phone (414) 453-7020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3269MNMDChiropractor
2358-035WIMDCorneal and Contact Management Optometrist
2358WIMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Wisconsin, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Wisconsin, LLC Optometrist CurrentSince Aug 18, 2025 Accepting new patients
Myeyedr Optometry of Wisconsin, LLC Optometrist CurrentSince Aug 18, 2025 Accepting new patients

Locations

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

2305 30th Ave
Kenosha, WI 53144
Phone (262) 597-2020

14151 W National Ave
New Berlin, WI 53151
Phone (414) 541-2100

2505 N Mayfair Rd
Ste 100
Wauwatosa, WI 53226
Phone (414) 453-7020

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1143504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1407817752",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "412 HIGHLAND BLVD",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530389504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 HIGHLAND BLVD",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530389504",
            "telephone_number": "920-390-9038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOK",
        "first_name": "MARK",
        "middle_name": "F.",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-28",
        "last_updated": "2026-07-13",
        "certification_date": "2025-11-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "2358-035",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "WI",
            "license": "2358-035",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38724000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson Creek, WI

Sources for this page

Verify at the official NPI Registry.