MEDICARE: SOUTHLANDS VISION ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1184645178
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHLANDS VISION ASSOCIATES

Provider Business Mailing Address
First Line	:	6290 S MAIN ST STE 100
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80016-5379
Country	:	US
Telephone Number	:	303-766-0545
Fax Number	:	303-766-0624

Provider Business Practice Location Address
First Line	:	6290 S MAIN ST
Second Line	:	SUITE 101
City	:	AURORA
State	:	CO
Zip	:	80016-5322
Country	:	US
Telephone Number	:	720-480-4711
Fax Number	:	720-870-9438

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	DR. KRISTEN C NICHOLSON
Credential	:	O.D.
Telephone Number	:	303-755-0545

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	01/15/2026

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