Provider Demographics
NPI:1164607271
Name:STEVEN G BEALS OD PA
Entity Type:Organization
Organization Name:STEVEN G BEALS OD PA
Other - Org Name:BEALS OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:GUS
Authorized Official - Last Name:BEALS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:320-269-6822
Mailing Address - Street 1:209 N 1ST ST
Mailing Address - Street 2:P O BOX 218
Mailing Address - City:MONTEVIDEO
Mailing Address - State:MN
Mailing Address - Zip Code:56265-1403
Mailing Address - Country:US
Mailing Address - Phone:320-269-6822
Mailing Address - Fax:320-269-6115
Practice Address - Street 1:209 N 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTEVIDEO
Practice Address - State:MN
Practice Address - Zip Code:56265-1403
Practice Address - Country:US
Practice Address - Phone:320-269-6822
Practice Address - Fax:320-269-6115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT65284Medicare UPIN