Provider Demographics
NPI:1164493391
Name:RUBSAM, JOHN STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:RUBSAM
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 1:71 CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405
Mailing Address - Country:US
Mailing Address - Phone:203-481-5909
Mailing Address - Fax:203-483-5289
Practice Address - Street 1:71 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405
Practice Address - Country:US
Practice Address - Phone:203-481-5909
Practice Address - Fax:203-483-5289
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1022152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090001022CT01OtherANTHEM BLUE CROSS ID
CT615076OtherCONNECTICARE ID
CTOV1151OtherHEALTHNET OF CONN. ID
CT004075511Medicaid
CTP1285753OtherOXFORD HEATH ID
CT4419937OtherAETNA ID
CTT22335Medicare UPIN
CT004075511Medicaid