Provider Demographics
NPI:1497116677
Name:ETERNAL VISION, P.C.
Entity Type:Organization
Organization Name:ETERNAL VISION, P.C.
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BEYNON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-520-1929
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:605-520-1929
Mailing Address - Fax:
Practice Address - Street 1:1612 EGLIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-6110
Practice Address - Country:US
Practice Address - Phone:605-348-4778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD609152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty