Provider Demographics
NPI:1083790687
Name:CERB ENTERPRISES, INC
Entity Type:Organization
Organization Name:CERB ENTERPRISES, INC
Other - Org Name:TOWN & COUNTRY OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SEC'Y/TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CLEAVELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-578-1995
Mailing Address - Street 1:409 N TEJON ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1101
Mailing Address - Country:US
Mailing Address - Phone:719-578-1995
Mailing Address - Fax:719-590-9353
Practice Address - Street 1:409 N TEJON ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1101
Practice Address - Country:US
Practice Address - Phone:719-578-1995
Practice Address - Fax:719-590-9353
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact LensGroup - Multi-Specialty
Not Answered156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens FitterGroup - Multi-Specialty
Not Answered156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0269230002Medicare ID - Type UnspecifiedOPTICAL