MARK KORTHALS (OD) – Optometrist, NPI 1215091749

MARK KORTHALS (OD) is a healthcare provider. based in Maple grove, Minnesota. specializing in OPTOMETRY. They hold the professional credentials OD. They hold a License No. 2972 (MN). The NPI Number for MARK KORTHALS (OD) is 1215091749

Main info

Male
22 Years Of Experience
Accepts Medicare Assignment
Name
MARK KORTHALS (OD)
NPI
1215091749
Phone
(763) 420-5112
Address
13195 WEAVER LAKE RD
Enumeration Date
20 December 2006
Last Update Date
4 September 2015

Doctor Profile

Medical School Name
ILLINOIS COLLEGE OF OPTOMETRY AT CHICAGO
Secondary Phone
7632412083
Graduation Year
2004 (22 years ago)
PAC ID
6002875879
Group Practice PAC ID
1557528841
Professional Enrollment ID
I20041007000195
Address ID
MN553301287EL19576NWXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

879 OPTOMETRY in MN

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Provider Addresses for MARK KORTHALS (OD)

  • Pearle Vision, 13195, Weaver Lake Road, Maple Grove, Hennepin County, Minnesota, 55369, United States

    MAPLE GROVE, MN 553699410

    Phone: (763) 420-5112

    Fax: (763) 420-6957

    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 2 Open Payments records for all available years, with a total value of $37.

Total Amount is formed as General ($37) + Research ($0) + Ownership ($0) = $37.

Last reported payment date: 2023-11-28 • Largest payer in this snapshot: CooperVision Inc. ($21).

Total Amount

$37

General + Research + Ownership

Payments

2

Total payment records

General Amount

$37

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2023-11-28

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2004-10-07

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20041007000195IOptometryMNTBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
92014Established patient complete exam of visual system3030$0
92004New patient complete exam of visual system1212$0
View full utilization report →

Insurance plans in this area (ZIP 55369)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1557528841View full group profile
NameSpecialtyState
-MN
O P T O M E T R YMN
O P T O M E T R YMN
O P T O M E T R YMN
O P T O M E T R YMN
O P T O M E T R YIA

Reviews

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Frequently asked questions

How do payers reference MARK KORTHALS (OD)?
For MARK KORTHALS (OD), use NPI 1215091749 as the unique 10-digit identifier.
Is MARK KORTHALS (OD) still an active registrant?
MARK KORTHALS (OD) carries an active NPI according to the public dataset.
How would a patient describe MARK KORTHALS (OD)'s focus?
For MARK KORTHALS (OD), the primary taxonomy reads as Optometrist. Clinical services aligned with this taxonomy classification.
Is MARK KORTHALS (OD) located near Maple Grove?
MARK KORTHALS (OD) currently maps to Maple Grove, Minnesota in this extract.
When was this NPI issued?
Enumeration for MARK KORTHALS (OD) is noted as December 20, 2006 where the registry provides it.

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