Individual
DR. MARK T MCDERMOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4243 4TH AVE S, MINNEAPOLIS, MN 55409-2113
(612) 821-2003
(612) 821-2818
Mailing address
4243 4TH AVE S, MINNEAPOLIS, MN 55409-2113
(612) 821-2003
(612) 821-2818
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
02169
IA
152W00000X
Optometrist
Primary
2594
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
124899
U CARE
MN
05
—
152713400
—
MN
01
—
22 07646
MEDICA
MN
01
—
26613
HEALTH PARTNERS
MN
01
—
57D32MC
BLUE CROSS BLUE SHIELD
MN
01
—
615152747
METROPOLITAN HEALTH PLAN
MN
Enumeration date
02/24/2006
Last updated
06/16/2025
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