Provider Demographics
NPI:1043821861
Name:VALOR VISION CLINIC LLC
Entity Type:Organization
Organization Name:VALOR VISION CLINIC LLC
Other - Org Name:MARGARET DIXON OD
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:CLINIC
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-500-6864
Mailing Address - Street 1:8884 WHITE PRAIRIE VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-5302
Mailing Address - Country:US
Mailing Address - Phone:719-500-6864
Mailing Address - Fax:
Practice Address - Street 1:4425 VENETUCCI BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4013
Practice Address - Country:US
Practice Address - Phone:719-306-1347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty