Provider Demographics
NPI:1528068152
Name:BEYNON, CHAD DONALD (OD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:DONALD
Last Name:BEYNON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 29TH ST SE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-9123
Mailing Address - Country:US
Mailing Address - Phone:605-882-2020
Mailing Address - Fax:
Practice Address - Street 1:905 29TH ST SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-9123
Practice Address - Country:US
Practice Address - Phone:605-882-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-26
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9203452Medicaid
SDV07630Medicare UPIN
SD9203452Medicaid