MEDICARE: MOUNT HOLLY EYE CLINIC, OD, PA

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	0928G	OTHER	NC	BLUE CROSS/BLUE SHIELD
3	12304	OTHER	NC	SPECTERA
4	4622	OTHER	NC	DAVIS VISION
5	OP0469	OTHER	NC	EYEMED
6	NC 1387	OTHER	NC	VISION BENEFITS OF AMERIC

General Provider Information

NPI Number	:	1720261662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOUNT HOLLY EYE CLINIC, OD, PA

Provider Business Mailing 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

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	:	OWNER
Name	:	DR. ANGELA MARIE FOX-PUTNAM
Credential	:	OD
Telephone Number	:	704-822-0099

Provider Enumeration Date	:	12/13/2007
Last Update Date	:	01/14/2010

Similar Medicare Providers

1992785836 — DR. ANGELA MARIE FOX-PUTNAM OD
Practice Location Address:

612 S MAIN ST
MOUNT HOLLY, NC
28120-1653

Practice Phone: 704-822-0099
Practice Fax: 704-822-0077

1083434740 — MYEYEDR OPTOMETRY OF NORTH CAROLINA, PLLC
Practice Location Address:

612 S MAIN ST
MOUNT HOLLY, NC
28120-1653

Practice Phone: 704-822-0099
Practice Fax: 704-822-0077

1255487682 — MRS. KATHRYN WRIGHT BIRZON
Practice Location Address:

104 MOUNT GREY RD
SETAUKET, NY
11733-1653

Practice Phone: 631-689-1735
Practice Fax: 631-689-0625

1558353896 — DR. GREGORY LEE GLASS MD
Practice Location Address:

125 W CATAWBA AVE
MOUNT HOLLY, NC
28120-1601

Practice Phone: 704-827-3014
Practice Fax: 704-822-9114

1588650394 — JOHN MARTIN BRADSHAW PA-C
Practice Location Address:

112 WOODLAWN RD
MOUNT HOLLY, NC
28120-1775

Practice Phone: 704-827-3575
Practice Fax: 704-827-0840

1003890328 — MS. LESLEY M PACITTO PT
Practice Location Address:

420 E CENTRAL AVE
MOUNT HOLLY, NC
28120-2116

Practice Phone: 980-277-2770
Practice Fax: 980-209-6560

Directions to “MOUNT HOLLY EYE CLINIC, OD, PA ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.