Gordon Wesley Molenaar, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

466097 Issued in IL

Practice address

3546 Ridge Road
Lansing, IL 60438

Phone

(708) 474-0078

Fax

(708) 474-0141

NPI assigned

Sep 20, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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 2

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Molenaar Eyecare Specialists LTD

  • Optometrist
  • Lansing, IL
  • NPI 1558468660
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528165669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3546 RIDGE ROAD",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "60438",
            "telephone_number": "708-474-0078",
            "fax_number": "708-474-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3546 RIDGE ROAD",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "60438",
            "telephone_number": "708-474-0078",
            "fax_number": "708-474-0141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOLENAAR",
        "first_name": "GORDON",
        "middle_name": "WESLEY",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "466097",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD IL",
            "identifier": "1684016",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "00224420001",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cynthia Lynette Michel
• Melinda Miller, BCBA
• Brittany Mitacek, ATC
• Molenaar Eyecare Specialists LTD
• Brant Tregellas Molenaar, OD
• Matthew Molenaar, LCSW
• Momentum Behavior Services LLC
• Shinora Montgomery
• Crystal Moore
• Jennifer J Moore, DO

• Optometrist in Lansing, IL
• Providers in Lansing, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.