Provider Demographics
NPI:1477762656
Name:VIETH, CHAD (OD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:VIETH
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 1:2715 DAMON ST
Mailing Address - Street 2:
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3899
Mailing Address - Country:US
Mailing Address - Phone:715-834-8471
Mailing Address - Fax:715-834-8964
Practice Address - Street 1:2715 DAMON ST
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3899
Practice Address - Country:US
Practice Address - Phone:715-834-8471
Practice Address - Fax:715-834-8964
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6126152W00000X
IA02382152W00000X
MN2841152W00000X
WI2827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU83040Medicare UPIN