Molly June Stacks, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046.011735 Issued in IL

Practice address

2121 S State Route 157
Edwardsville, IL 62025-3691

Phone

(618) 656-7774

Fax

(618) 656-0536

NPI assigned

Mar 28, 2023

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

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

Specialty

Optometry

Education

University of Missouri St Louis - School of Optometry, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clarkson Optometry Illinois, PCGroup PAC ID 7012292147, 16 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mollystacks@direct.eyecare-partners.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Clarkson Optometry Illinois, P.C.

  • Optometrist
  • Ballwin, MO
  • NPI 1548635758

  IL

  Medicare reassignment Care Compare group NPD
• Clarkson Optometry Illinois, P.C.

  • Optometrist
  • Centralia, IL
  • NPI 1730373648
  NPD
• 3F Vision LLC

  • Optometrist
  • Highland, IL
  • NPI 1770866428
  NPD (past)
• Clarkson Optometry Illinois PC

  • Optometrist
  • Shiloh, IL
  • NPI 1457303125
  NPD (past)
• Clarkson Eyecare

  • Optometrist
  • Eureka, MO
  • NPI 1205817731
  NPD (past)
• Clarkson Optometry Inc

  • Optometrist
  • Pacific, MO
  • NPI 1215980875
  NPD (past)

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1164126793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 207163",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "753207163",
            "telephone_number": "636-200-4393",
            "fax_number": "636-527-0766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 S STATE ROUTE 157",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620253691",
            "telephone_number": "618-656-7774",
            "fax_number": "618-656-0536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3405 Nameoki Rd",
            "address_purpose": "LOCATION",
            "city": "Granite City",
            "state": "IL",
            "postal_code": "620403709",
            "country_code": "US",
            "telephone_number": "618-219-8909",
            "fax_number": "618-219-8910",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6663 Edwardsville Crossing Dr",
            "address_purpose": "LOCATION",
            "city": "Edwardsville",
            "state": "IL",
            "postal_code": "620252704",
            "country_code": "US",
            "telephone_number": "618-659-2320",
            "fax_number": "618-655-0375",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 Belt Line Rd",
            "address_purpose": "LOCATION",
            "city": "Collinsville",
            "state": "IL",
            "postal_code": "622344400",
            "country_code": "US",
            "telephone_number": "618-223-5212",
            "fax_number": "618-223-5213",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1819 Homer M Adams Pkwy",
            "address_purpose": "LOCATION",
            "city": "Alton",
            "state": "IL",
            "postal_code": "620025606",
            "country_code": "US",
            "telephone_number": "618-208-0585",
            "fax_number": "618-208-0586",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10 Lincoln Hwy Ste 101",
            "address_purpose": "LOCATION",
            "city": "Fairview Heights",
            "state": "IL",
            "postal_code": "622082100",
            "country_code": "US",
            "telephone_number": "618-624-0222",
            "fax_number": "618-624-4930",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "12603 State Route 143 Ste F",
            "address_purpose": "LOCATION",
            "city": "Highland",
            "state": "IL",
            "postal_code": "622491199",
            "country_code": "US",
            "telephone_number": "618-882-4262",
            "fax_number": "618-882-4263",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2645 N Illinois St",
            "address_purpose": "LOCATION",
            "city": "Swansea",
            "state": "IL",
            "postal_code": "622262302",
            "country_code": "US",
            "telephone_number": "618-767-5100",
            "fax_number": "618-767-5101",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STACKS",
        "first_name": "MOLLY",
        "middle_name": "JUNE",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-03-28",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046.011735",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• St. John'S Healing Community Board
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• Optometrist in Edwardsville, IL
• Providers in Edwardsville, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.