Active NPI
HV Pueblo South LLC
Doing business as Academy Kids Vision
- Clinic/Center
- Pueblo, CO
National Provider Identifier
1700247228
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- HV PUEBLO SOUTH LLC
- Doing business as
- Academy Kids Vision
- Practice address
- 1725 S Pueblo Blvd
Pueblo, CO 81005-2103 - Phone
- (719) 281-2633
- Fax
- (719) 281-2634
- NPI assigned
- Mar 10, 2016
- 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 | |||
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
1725 S Pueblo Blvd
Pueblo, CO 81005-2103
Mailing address
2221 E Bijou St
Ste 100
Colorado Springs, CO 80909
Phone (719) 281-2633
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 68820071 | Medicaid | CO |
Other names 1
- Academy Kids Vision
National Provider Directory
National Provider Directory- Tax ID family
- HV Pueblo South 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": "1457568000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1618358400000",
"number": "1700247228",
"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": "719-281-2633",
"fax_number": "719-281-2634"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1725 S PUEBLO BLVD",
"city": "PUEBLO",
"state": "CO",
"postal_code": "810052103",
"telephone_number": "719-281-2633",
"fax_number": "719-281-2634"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "HV PUEBLO SOUTH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2016-03-10",
"last_updated": "2021-04-14",
"certification_date": "2021-04-14",
"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": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "68820071",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Academy Kids Vision",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Academy Kids Vision",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pueblo, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.