Provider Demographics
NPI:1760091680
Name:DIXON, CORRI COLLINS (OD)
Entity Type:Individual
Prefix:
First Name:CORRI
Middle Name:COLLINS
Last Name:DIXON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CORRI
Other - Middle Name:GRACE
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1020 GIBSON BAY DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3448
Mailing Address - Country:US
Mailing Address - Phone:859-623-8141
Mailing Address - Fax:859-623-8141
Practice Address - Street 1:1020 GIBSON BAY DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3448
Practice Address - Country:US
Practice Address - Phone:859-623-3358
Practice Address - Fax:859-623-8141
Is Sole Proprietor?:No
Enumeration Date:2020-07-27
Last Update Date:2023-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2180152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist