Individual
DR. GORDON WESLEY MOLENAAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3546 RIDGE ROAD, LANSING, IL 60438
(708) 474-0078
(708) 474-0141
Mailing address
3546 RIDGE ROAD, LANSING, IL 60438
(708) 474-0078
(708) 474-0141
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
466097
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00224420001
DMERC
IL
01
—
1684016
BLUE CROSS BLUE SHIELD IL
—
Enumeration date
09/20/2006
Last updated
07/08/2007
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