Organization
HV PUEBLO SOUTH LLC
Active
Other names
Academy Kids 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
1725 S PUEBLO BLVD, PUEBLO, CO 81005-2103
(719) 281-2633
(719) 281-2634
Mailing address
2221 E BIJOU ST, STE 100, COLORADO SPRINGS, CO 80909
(719) 281-2633
(719) 281-2634
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
68820071
—
CO
Enumeration date
03/10/2016
Last updated
04/14/2021
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