MEDICARE: DR. ANGELA MARIE FOX-PUTNAM OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1387	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4622	OTHER	NC	DAVIS VISION
3	12304	OTHER	NC	SPECTERA
4	OP069	OTHER	NC	EYEMED
5	0928G	OTHER	NC	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1992785836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA MARIE FOX-PUTNAM OD

Provider Business Mailing Address
First Line	:	612 SOUTH MAIN STREET
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-1653
Country	:	US
Telephone Number	:	704-822-0099
Fax Number	:	704-822-0077

Provider Business Practice Location Address
First Line	:	612 S MAIN ST
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-1653
Country	:	US
Telephone Number	:	704-822-0099
Fax Number	:	704-822-0077

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2006
Last Update Date	:	10/16/2024

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