Provider Demographics
NPI:1184645178
Name:SOUTHLANDS VISION ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHLANDS VISION ASSOCIATES
Other - Org Name:ALTITUDE EYE CARE AT SOUTHLANDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:NICHOLSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:303-755-0545
Mailing Address - Street 1:6290 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-5379
Mailing Address - Country:US
Mailing Address - Phone:303-766-0545
Mailing Address - Fax:303-766-0624
Practice Address - Street 1:6290 S MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5322
Practice Address - Country:US
Practice Address - Phone:720-480-4711
Practice Address - Fax:720-870-9438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty