Provider Demographics
NPI:1598146490
Name:DEIBERT EYE CARE LLC
Entity Type:Organization
Organization Name:DEIBERT EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DEIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:414-383-4855
Mailing Address - Street 1:13450 W COLD SPRING RD
Mailing Address - Street 2:
Mailing Address - City:NEW BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53151-6958
Mailing Address - Country:US
Mailing Address - Phone:414-383-4855
Mailing Address - Fax:
Practice Address - Street 1:3355 S 27TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53215-4303
Practice Address - Country:US
Practice Address - Phone:414-383-4855
Practice Address - Fax:414-383-4946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty