Provider Demographics
NPI:1265442115
Name:RUTSTEIN, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:RUTSTEIN
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 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HPB G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0010
Mailing Address - Country:US
Mailing Address - Phone:205-975-2020
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT046TA120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059817Medicaid
ALA1716 636005396OtherVISION SERVICE PLAN
AL000059878Medicaid
MS07276757Medicaid
LA1585955Medicaid
AL51059817OtherBCBS OF ALABAMA
AL51059878OtherBCBS
ALT69052OtherVIVA
LA1585955Medicaid
AL000059817Medicaid
ALA1716 636005396OtherVISION SERVICE PLAN
AL51059817OtherBCBS OF ALABAMA
AL1387502Medicare ID - Type UnspecifiedTRAVELERS
AL410021248Medicare ID - Type UnspecifiedRAILROAD