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General NPI Number Information
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NPI Number | 1265836043
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Entity Type | Organization
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Legal Business Name | AKVC CENTRAL LLC
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Dates
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Enumeration Date | 10/22/2014
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 883 N ACADEMY BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-8307
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Country | US
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Telephone | 714-442-0071
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Fax | 719-473-5303
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Provider Business Mailing Address
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Address Line | 2221 E BIJOU ST. STE. 100
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909
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Country | US
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Telephone | 719-442-0071
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Fax | 719-473-5303
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | MS. SAMANTHA B LEBLANC
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Credential |
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Telephone | 719-323-2372
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number |
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License Number State |
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