# ACADEMY KIDS VISION CENTER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Academy Kids Dental Vision and Orthodontics
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639339930
- **Authorized official:** MS. SAMANTHA B LEBLANC (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (719) 323-2372

## Contact information

- **Practice address:** 2436 S ACADEMY BLVD, COLORADO SPRINGS, CO 80916-2408
- **Practice address phone:** (719) 391-2336
- **Practice address fax:** (719) 391-1625
- **Mailing address:** 2221 E BIJOU ST., STE. 100, COLORADO SPRINGS, CO 80909
- **Mailing address phone:** (719) 391-2336
- **Mailing address fax:** (719) 391-1625

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | — | NULL | — |
| 152W00000X | Optometrist | — | — | — |
| 261Q00000X | Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/11/2008
- **Last updated:** 04/29/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 25100343 | — | CO |