Provider Demographics
NPI:1558315754
Name:CLEAVELAND, TERRY W (CERTIFIED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:W
Last Name:CLEAVELAND
Suffix:
Gender:M
Credentials:CERTIFIED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3361 N ACADEMY BLVD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5103
Mailing Address - Country:US
Mailing Address - Phone:719-573-9425
Mailing Address - Fax:719-597-6113
Practice Address - Street 1:3361 N ACADEMY BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5103
Practice Address - Country:US
Practice Address - Phone:719-573-9425
Practice Address - Fax:719-597-6113
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician