Provider Demographics
NPI:1215669536
Name:GLOVER, MOLLY CAROL
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:CAROL
Last Name:GLOVER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 ROLLING HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29640-7109
Mailing Address - Country:US
Mailing Address - Phone:864-859-6216
Mailing Address - Fax:864-855-8099
Practice Address - Street 1:115 ROLLING HILLS CIR
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29640-7109
Practice Address - Country:US
Practice Address - Phone:864-859-6216
Practice Address - Fax:864-855-8099
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1274156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician