Provider Demographics
NPI:1790756476
Name:RABINS, JOHN MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:MICHAEL
Last Name:RABINS
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 1:5630 PIEDRA VIS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-3257
Mailing Address - Country:US
Mailing Address - Phone:719-495-2999
Mailing Address - Fax:
Practice Address - Street 1:3585 VAN TEYLINGEN DR
Practice Address - Street 2:OPTOM EYES
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-4875
Practice Address - Country:US
Practice Address - Phone:719-550-3937
Practice Address - Fax:719-268-6694
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO 2178152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO5024000001OtherMEDICARE DME
CO24509027Medicaid
CO24509027Medicaid
CO5024000001OtherMEDICARE DME