Provider Demographics
NPI:1467888693
Name:RUBIN, LISA ELLEN
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ELLEN
Last Name:RUBIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:ELLEN
Other - Last Name:RUBIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:800 HURON RD E
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1121
Mailing Address - Country:US
Mailing Address - Phone:216-781-7900
Mailing Address - Fax:
Practice Address - Street 1:800 HURON RD E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1121
Practice Address - Country:US
Practice Address - Phone:216-781-7900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS4508156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4360507Medicaid