Provider Demographics
NPI:1427089051
Name:GLOVER, MARION SHERILL (OD, PA)
Entity type:Individual
Prefix:
First Name:MARION
Middle Name:SHERILL
Last Name:GLOVER
Suffix:
Gender:M
Credentials:OD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 557
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NC
Mailing Address - Zip Code:27569-0557
Mailing Address - Country:US
Mailing Address - Phone:919-936-2020
Mailing Address - Fax:919-936-2444
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:919-936-2444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1046152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09324OtherBC/BS OF NC
NC8909324Medicaid
NC246362AMedicare PIN
NC0142380001Medicare NSC
NCT64902NCMedicare UPIN