Provider Demographics
NPI:1710922414
Name:BEILBY, SHAWN DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:DAVID
Last Name:BEILBY
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 1:215 N K AVE
Mailing Address - Street 2:
Mailing Address - City:VINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52349-2506
Mailing Address - Country:US
Mailing Address - Phone:319-472-3848
Mailing Address - Fax:319-472-3192
Practice Address - Street 1:215 N K AVE
Practice Address - Street 2:
Practice Address - City:VINTON
Practice Address - State:IA
Practice Address - Zip Code:52349-2506
Practice Address - Country:US
Practice Address - Phone:319-472-3848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAPENDING152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA21192OtherBCBS
IADF5967OtherGBA/RR
IA0494294Medicaid
IAI19252Medicare PIN
IA0494294Medicaid
IADF5967OtherGBA/RR