DR. MARK BUBOLTZ (O.D.) – Corneal and Contact Management Optometrist, NPI 1205249620
Corneal and Contact Management Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
879 OPTOMETRY in MN
Provider Addresses for DR. MARK BUBOLTZ (O.D.)
9801 DUPONT AVE S
SUITE 425
BLOOMINGTON, MN 554313100
Phone: (952) 888-5800
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 17 Open Payments records for all available years, with a total value of $1,119.
Total Amount is formed as General ($1,119) + Research ($0) + Ownership ($0) = $1,119.
Last reported payment date: 2024-11-11 • Largest payer in this snapshot: VISIONARY OPTICS LLC ($350).
Total Amount
$1,119
General + Research + Ownership
Payments
17
Total payment records
General Amount
$1,119
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| VISIONARY OPTICS LLC | $350 |
| Dompe US, Inc. | $212 |
| Glaukos Corporation | $210 |
| BIOTISSUE HOLDINGS, INC. | $125 |
| ABBVIE INC. | $86 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2014-06-18
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20140618001231 | I | Optometry | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 472 | 327 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 156 | 138 | $0 |
| 92014 | Established patient complete exam of visual system | 123 | 122 | $0 |
| 92083 | Exam of visual field with extended testing | 108 | 96 | $0 |
| 92134 | Imaging of retina | 103 | 89 | $0 |
Insurance plans in this area (ZIP 55431)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O P H T H A L M O L O G Y | MN | |
| O P T O M E T R Y | MN | |
| O P H T H A L M O L O G Y | MN | |
| O P H T H A L M O L O G Y | MN | |
| O P T O M E T R Y | MN | |
| O P H T H A L M O L O G Y | MN | |
| - | MN | |
| O P T O M E T R Y | MN | |
| O P T O M E T R Y | MN | |
| Physician Assistant | MN |
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