Provider Demographics
NPI:1043281017
Name:DEEBLE, HEATHER (OD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:DEEBLE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1122
Mailing Address - Country:US
Mailing Address - Phone:973-467-2288
Mailing Address - Fax:973-467-1455
Practice Address - Street 1:249 MAIN ST
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1122
Practice Address - Country:US
Practice Address - Phone:973-467-2288
Practice Address - Fax:973-467-1455
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00138000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJV07320Medicare UPIN