Basic Information
| Provider Information | |||||||||
| NPI: | 1982817193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RUBIN | ||||||||
| FirstName: | JACK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11406 SAN JOSE BLVD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322237963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042603839 | ||||||||
| FaxNumber: | 9042607879 | ||||||||
| Practice Location | |||||||||
| Address1: | 11406 SAN JOSE BLVD | ||||||||
| Address2: | STE 1 | ||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322237963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042603839 | ||||||||
| FaxNumber: | 9042607879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 04/11/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152WC0802X | OPC1114 | FL | Y | Eye and Vision Services Providers | Optometrist | Corneal and Contact Management |
No ID Information.