Provider Demographics
NPI:1902820582
Name:ACADEMY VISION SCIENCE CLINIC PC
Entity Type:Organization
Organization Name:ACADEMY VISION SCIENCE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:VANCAMP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-598-6000
Mailing Address - Street 1:5955 LEHMAN DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-3434
Mailing Address - Country:US
Mailing Address - Phone:719-598-6000
Mailing Address - Fax:719-785-5451
Practice Address - Street 1:5955 LEHMAN DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3434
Practice Address - Country:US
Practice Address - Phone:719-598-6000
Practice Address - Fax:719-785-5451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COOPT1190152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COU35953Medicare UPIN
COC521328Medicare ID - Type Unspecified