Provider Demographics
NPI:1740384361
Name:DIXON, GREGORY KENNETH (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:KENNETH
Last Name:DIXON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:696 MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3971
Mailing Address - Country:US
Mailing Address - Phone:540-825-6161
Mailing Address - Fax:540-825-9612
Practice Address - Street 1:696 MEADOWBROOK DR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3971
Practice Address - Country:US
Practice Address - Phone:540-825-6161
Practice Address - Fax:540-825-9612
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000159152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618000159OtherBOARD OF OPTOMETRY
VA0618000159OtherBOARD OF OPTOMETRY
VA00605G77Medicare ID - Type Unspecified
VAU09643Medicare UPIN