Healthcare Provider Details

I. General information

NPI: 1265836043
Provider Name (Legal Business Name): AKVC CENTRAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

883 N ACADEMY BLVD
COLORADO SPRINGS CO
80909-8307
US

IV. Provider business mailing address

2221 E BIJOU ST. STE. 100
COLORADO SPRINGS CO
80909
US

V. Phone/Fax

Practice location:
  • Phone: 714-442-0071
  • Fax: 719-473-5303
Mailing address:
  • Phone: 719-442-0071
  • Fax: 719-473-5303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: MS. SAMANTHA B LEBLANC
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 719-323-2372