Provider Demographics
NPI:1700056041
Name:DR. CHAD D. KALIL, OPTOMETRIST P.C.
Entity Type:Organization
Organization Name:DR. CHAD D. KALIL, OPTOMETRIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:KALIL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-690-1103
Mailing Address - Street 1:236 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1178
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2233 6TH ST
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-1731
Practice Address - Country:US
Practice Address - Phone:605-692-3595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDDB053107261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center