Healthcare Provider Details

I. General information

NPI: 1902820582
Provider Name (Legal Business Name): ACADEMY VISION SCIENCE CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 LEHMAN DR
COLORADO SPRINGS CO
80918-3434
US

IV. Provider business mailing address

5955 LEHMAN DR
COLORADO SPRINGS CO
80918-3434
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-6000
  • Fax: 719-785-5451
Mailing address:
  • Phone: 719-598-6000
  • Fax: 719-785-5451

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberOPT1190
License Number StateCO

VIII. Authorized Official

Name: DR. JAMES THOMAS VANCAMP
Title or Position: PRESIDENT / OWNER / OPTOMETRIST
Credential: OD
Phone: 719-598-6000