Basic Information
| Provider Information | |||||||||
| NPI: | 1750745105 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KING | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | DIXON | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD, FAAO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8884 WHITE PRAIRIE VW | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809245302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195006864 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 883 N ACADEMY BLVD | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809098307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194420071 | ||||||||
| FaxNumber: | 7194735303 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/12/2016 | ||||||||
| LastUpdateDate: | 12/08/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPT0003316 | CO | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.