Provider Demographics
NPI:1821281197
Name:GREGORY K. DIXON, OD, LLC
Entity Type:Organization
Organization Name:GREGORY K. DIXON, OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:K
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-825-6161
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000159152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0139370001Medicare NSC