Healthcare Provider Details

I. General information

NPI: 1598146490
Provider Name (Legal Business Name): DEIBERT EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15205 W GREENFIELD AVE
NEW BERLIN WI
53151-1519
US

IV. Provider business mailing address

15205 W GREENFIELD AVE
NEW BERLIN WI
53151-1519
US

V. Phone/Fax

Practice location:
  • Phone: 262-317-8900
  • Fax: 262-786-4639
Mailing address:
  • Phone: 262-317-8900
  • Fax: 262-786-4639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3165
License Number StateWI

VIII. Authorized Official

Name: RYAN K DEIBERT
Title or Position: OWNER
Credential: OD
Phone: 414-317-8900