Provider Demographics
NPI:1558468660
Name:MOLENAAR EYECARE SPECIALISTS LTD
Entity type:Organization
Organization Name:MOLENAAR EYECARE SPECIALISTS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:WESLEY
Authorized Official - Last Name:MOLENAAR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-474-0078
Mailing Address - Street 1:3546 RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:IL
Mailing Address - Zip Code:60438
Mailing Address - Country:US
Mailing Address - Phone:708-474-0078
Mailing Address - Fax:708-474-0141
Practice Address - Street 1:3546 RIDGE ROAD
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:IL
Practice Address - Zip Code:60438
Practice Address - Country:US
Practice Address - Phone:708-474-0078
Practice Address - Fax:708-474-0141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL410037747OtherRAILROAD MEDICARE
T36604Medicare UPIN
IL410037747OtherRAILROAD MEDICARE
IL507490Medicare ID - Type Unspecified