Provider Demographics
NPI:1942455878
Name:CHARLES RUBIN MD
Entity Type:Organization
Organization Name:CHARLES RUBIN MD
Other - Org Name:RIVERSIDE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPHTHALMALOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-798-7164
Mailing Address - Street 1:95 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2720
Mailing Address - Country:US
Mailing Address - Phone:607-798-7164
Mailing Address - Fax:607-798-0879
Practice Address - Street 1:95 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-2720
Practice Address - Country:US
Practice Address - Phone:607-798-7164
Practice Address - Fax:607-798-0879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101191-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1256630001Medicare NSC