Provider Demographics
NPI:1962484162
Name:RUBIN, GARY VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:VINCENT
Last Name:RUBIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7001 W ARCHER AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60638-2201
Mailing Address - Country:US
Mailing Address - Phone:773-229-8818
Mailing Address - Fax:773-229-8423
Practice Address - Street 1:7001 W ARCHER AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60638-2201
Practice Address - Country:US
Practice Address - Phone:773-229-8818
Practice Address - Fax:773-229-8423
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036055869207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036055869Medicaid
IL180001220Medicare PIN
IL675790Medicare PIN
ILD14701Medicare UPIN
IL036055869Medicaid