Healthcare Provider Details

I. General information

NPI: 1750745105
Provider Name (Legal Business Name): MOLLY DIXON KING OD, FAAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2016
Last Update Date: 12/08/2021
Certification Date: 12/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 N ACADEMY BLVD
COLORADO SPRINGS CO
80909-8307
US

IV. Provider business mailing address

8884 WHITE PRAIRIE VW
COLORADO SPRINGS CO
80924-5302
US

V. Phone/Fax

Practice location:
  • Phone: 719-442-0071
  • Fax: 719-473-5303
Mailing address:
  • Phone: 719-500-6864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT0003316
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: