Provider Demographics
NPI:1356659163
Name:JAMES D RUBIN O.D. PC
Entity Type:Organization
Organization Name:JAMES D RUBIN O.D. PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-452-3937
Mailing Address - Street 1:2920 NE 60TH ST
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-2031
Mailing Address - Country:US
Mailing Address - Phone:816-452-3937
Mailing Address - Fax:816-455-2428
Practice Address - Street 1:2920 NE 60TH ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-2031
Practice Address - Country:US
Practice Address - Phone:816-452-3937
Practice Address - Fax:816-455-2428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02390152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty
No152WS0006XEye and Vision Services ProvidersOptometristSports VisionGroup - Single Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty
No152WX0102XEye and Vision Services ProvidersOptometristOccupational VisionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOT42507Medicare UPIN
MO0001977BMedicare PIN