Provider Demographics
NPI:1477607885
Name:RUBIN, ADAM PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PAUL
Last Name:RUBIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:18310 MONTGOMERY VILLAGE AVE STE 140
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3556
Mailing Address - Country:US
Mailing Address - Phone:301-869-4070
Mailing Address - Fax:301-869-0397
Practice Address - Street 1:18310 MONTGOMERY VILLAGE AVE STE 140
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3556
Practice Address - Country:US
Practice Address - Phone:301-869-4070
Practice Address - Fax:301-869-0397
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1M6012OtherPTAN
MD5779030001Medicare NSC
MDG01878M02Medicare PIN