Healthcare Provider Details

I. General information

NPI: 1013330208
Provider Name (Legal Business Name): AKVC NORTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 AUSTIN BLUFFS PKWY STE 120
COLORADO SPRINGS CO
80918-6663
US

IV. Provider business mailing address

2221 E BIJOU ST STE 100
COLORADO SPRINGS CO
80909-8009
US

V. Phone/Fax

Practice location:
  • Phone: 719-304-5400
  • Fax: 719-304-5409
Mailing address:
  • Phone: 719-576-1850
  • Fax: 719-576-1929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. SAMANTHA B LEBLANC
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 719-576-1850