Provider Demographics
NPI:1750745105
Name:KING, MOLLY DIXON (OD, FAAO)
Entity type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:DIXON
Last Name:KING
Suffix:
Gender:F
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:883 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-8307
Practice Address - Country:US
Practice Address - Phone:719-442-0071
Practice Address - Fax:719-473-5303
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT0003316152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist