Organization
AKVC CENTRAL LLC
Active
Other names
Academy Kids Dental and Vision
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SAMANTHA B LEBLANC (CREDENTIALING SPECIALIST)
(719) 323-2372
Entity
Organization
Contact information
Practice address
883 N ACADEMY BLVD, COLORADO SPRINGS, CO 80909-8307
(714) 442-0071
(719) 473-5303
Mailing address
2221 E BIJOU ST., STE. 100, COLORADO SPRINGS, CO 80909
(719) 442-0071
(719) 473-5303
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
152WP0200X
Pediatric Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
016627801
—
MD
05
—
019177299
—
DC
01
—
1796
STATE
KS
05
—
200532530C
—
KS
05
—
200871800A
—
OK
05
—
27952291
—
NM
01
—
3033
STATE
OK
05
—
310087377
—
MO
05
—
97789054
—
CO
01
—
DA2086
STATE
MD
01
—
OP1000412
STATE
DC
01
—
OPT.0001462
STATE
CO
01
—
OPT732
STATE
NM
Enumeration date
10/22/2014
Last updated
11/15/2021
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