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General NPI Number Information
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NPI Number | 1598146490
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Entity Type | Organization
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Legal Business Name | DEIBERT EYE CARE LLC
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 12/16/2025
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Provider Practice Location Address
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Address Line | 15205 W GREENFIELD AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-1519
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Country | US
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Telephone | 262-317-8900
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Fax | 262-786-4639
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Provider Business Mailing Address
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Address Line | 15205 W GREENFIELD AVE
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City | NEW BERLIN
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State | WI
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Zip | 53151-1519
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Country | US
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Telephone | 262-317-8900
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Fax | 262-786-4639
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Authorized Official
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Title or Position | OWNER
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Name | RYAN K DEIBERT
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Credential | OD
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Telephone | 414-317-8900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3165
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License Number State | WI
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