Mark Owen Moleski, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

4301043504 Issued in MI

Practice address

791 Kenmoor SE
Suite a Cascade Ophthalmology PC
Grand Rapids, MI 49546-8625

Phone

(616) 575-8200

Fax

(616) 954-9622

NPI assigned

Aug 23, 2005

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 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1124755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426464000000",
    "number": "1033102371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "791 KENMOOR SE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468625",
            "telephone_number": "616-575-8200",
            "fax_number": "616-954-9622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "791 KENMOOR SE",
            "address_2": "SUITE A CASCADE OPHTHALMOLOGY PC",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468625",
            "telephone_number": "616-575-8200",
            "fax_number": "616-954-9622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLESKI",
        "first_name": "MARK",
        "middle_name": "OWEN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-23",
        "last_updated": "2015-03-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301043504",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0358470002",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2116382",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "180410703",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samyrah Mohon
• Pam Mohrhardt, LPN
• Katherine Mae Mokma, BS
• Heather Jill Mol, PMHNP-BC
• Birgit Molenaar, PT
• Thomas Philip Moleski, OD
• Alvonte Molet
• Rosette Nsenga Molin, LLPC
• Adriana Molina-Schmuker, LLMSW
• Orea J Molina

• Ophthalmology Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Ophthalmology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.