MEDICARE: VALOR VISION CLINIC LLC

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

General Provider Information

NPI Number	:	1043821861
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VALOR VISION CLINIC LLC

Provider Business Mailing Address
First Line	:	8884 WHITE PRAIRIE VW
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80924-5302
Country	:	US
Telephone Number	:	719-500-6864
Fax Number	:

Provider Business Practice Location Address
First Line	:	4425 VENETUCCI BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4013
Country	:	US
Telephone Number	:	719-306-1347
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARGARET CLINIC DIXON
Credential	:	OD
Telephone Number	:	719-500-6864

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	10/02/2020

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