Provider Demographics
NPI:1063687002
Name:RUBEO, RALPH PETER (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:RALPH
Middle Name:PETER
Last Name:RUBEO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19801-3053
Mailing Address - Country:US
Mailing Address - Phone:302-654-1466
Mailing Address - Fax:302-654-1470
Practice Address - Street 1:811 N MARKET ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19801
Practice Address - Country:US
Practice Address - Phone:302-654-1466
Practice Address - Fax:302-654-1470
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE44006156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000883622Medicaid
DE4070340002Medicare PIN