Healthcare Provider Details

I. General information

NPI: 1992785836
Provider Name (Legal Business Name): ANGELA MARIE FOX-PUTNAM OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 S MAIN ST
MOUNT HOLLY NC
28120-1653
US

IV. Provider business mailing address

612 SOUTH MAIN STREET
MOUNT HOLLY NC
28120-1653
US

V. Phone/Fax

Practice location:
  • Phone: 704-822-0099
  • Fax: 704-822-0077
Mailing address:
  • Phone: 704-822-0099
  • Fax: 704-822-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1387
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: