Provider Demographics
NPI:1598981995
Name:BEALS, STEVEN GUS (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GUS
Last Name:BEALS
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 1:209 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
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN59851BEOtherBLUE CROSS BLUE SHIELD
MN5C001BEOtherBLUE CROSS BLUE SHIELD
MN59851BEOtherBLUE CROSS BLUE SHIELD