Provider Demographics
NPI:1659380194
Name:RUBIS, MARYANN KATHERINE (OD)
Entity Type:Individual
Prefix:DR
First Name:MARYANN
Middle Name:KATHERINE
Last Name:RUBIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 ALLEN ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01118-1803
Mailing Address - Country:US
Mailing Address - Phone:413-782-0030
Mailing Address - Fax:413-796-1985
Practice Address - Street 1:1515 ALLEN ST
Practice Address - Street 2:SUITE E
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01118-1803
Practice Address - Country:US
Practice Address - Phone:413-782-0030
Practice Address - Fax:413-796-1985
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3541152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0355852Medicaid
MAW15794OtherBLUE CROSS BLUE SHIELD
MA3541OtherMASSACHUSETTS LICENSE
MA435358Medicare ID - Type Unspecified435358
MAT95532Medicare UPIN