Active NPI
Akvc Central LLC
Doing business as Academy Kids Dental and Vision
- Pediatric Optometrist
- Colorado Springs, CO
National Provider Identifier
1265836043
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatric Optometrist
- Legal business name
- AKVC CENTRAL LLC
- Doing business as
- Academy Kids Dental and Vision
- Practice address
- 883 N Academy Blvd
Colorado Springs, CO 80909-8307 - Phone
- (714) 442-0071
- Fax
- (719) 473-5303
- NPI assigned
- Oct 22, 2014
- Last updated
- Nov 15, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Samantha B Leblanc
- Title
- Credentialing Specialist
- Phone
- (719) 323-2372
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | NU | ||
| Pediatric Optometrist | 152WP0200X | NU | Primary |
Addresses
Primary practice location
883 N Academy Blvd
Colorado Springs, CO 80909-8307
Mailing address
2221 E Bijou St.
Ste. 100
Colorado Springs, CO 80909
Phone (719) 442-0071
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DA2086 | Other | MD | STATE |
| 016627801 | Medicaid | MD | |
| 1796 | Other | KS | STATE |
| 200532530C | Medicaid | KS | |
| 27952291 | Medicaid | NM | |
| OP1000412 | Other | DC | STATE |
| 310087377 | Medicaid | MO | |
| OPT.0001462 | Other | CO | STATE |
| 019177299 | Medicaid | DC | |
| 3033 | Other | OK | STATE |
| 97789054 | Medicaid | CO | |
| OPT732 | Other | NM | STATE |
| 200871800A | Medicaid | OK |
Other names 1
- Academy Kids Dental and Vision
National Provider Directory
National Provider Directory- Tax ID family
- Akvc Central LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Ownership & related parties
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413936000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1636934400000",
"number": "1265836043",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2221 E BIJOU ST.",
"address_2": "STE. 100",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "80909",
"telephone_number": "719-442-0071",
"fax_number": "719-473-5303"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "883 N ACADEMY BLVD",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809098307",
"telephone_number": "714-442-0071",
"fax_number": "719-473-5303"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AKVC CENTRAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2014-10-22",
"last_updated": "2021-11-15",
"certification_date": "2021-11-15",
"status": "A",
"authorized_official_last_name": "LEBLANC",
"authorized_official_first_name": "SAMANTHA",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
"authorized_official_telephone_number": "719-323-2372",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "152WP0200X",
"taxonomy_group": "",
"desc": "Optometrist, Pediatrics",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "DA2086",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "016627801",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "1796",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200532530C",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "27952291",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "OP1000412",
"state": "DC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "310087377",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "OPT.0001462",
"state": "CO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "019177299",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "3033",
"state": "OK"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "97789054",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE",
"identifier": "OPT732",
"state": "NM"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200871800A",
"state": "OK"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Academy Kids Dental and Vision",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.