Provider Demographics
NPI:1982343323
Name:DEIBELE, PIERCE JONATHAN (OD)
Entity Type:Individual
Prefix:DR
First Name:PIERCE
Middle Name:JONATHAN
Last Name:DEIBELE
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 1:2000 PALM BEACH LAKES BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6504
Mailing Address - Country:US
Mailing Address - Phone:561-500-2020
Mailing Address - Fax:
Practice Address - Street 1:2000 PALM BEACH LAKES BLVD STE 400
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6504
Practice Address - Country:US
Practice Address - Phone:561-500-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist