Provider Demographics
NPI:1508533639
Name:GLOVER, MOLLY (OD)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201A WILSHIRE WAY
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9130
Mailing Address - Country:US
Mailing Address - Phone:919-223-0247
Mailing Address - Fax:
Practice Address - Street 1:110 E EDWARDS ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NC
Practice Address - Zip Code:27569-7279
Practice Address - Country:US
Practice Address - Phone:919-936-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist