Provider Demographics
NPI:1982682423
Name:RUBIN, DAVID M (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:M
Last Name:RUBIN
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 1:6002 POINTE WEST BLVD.
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-5531
Mailing Address - Country:US
Mailing Address - Phone:941-792-2020
Mailing Address - Fax:941-782-1089
Practice Address - Street 1:1550 E VENICE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34292-1661
Practice Address - Country:US
Practice Address - Phone:941-792-2020
Practice Address - Fax:941-782-1089
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078478800Medicaid
19329YOtherPTAN-VENICE
19329WOtherPTAN-SARASOTA
FL580001929OtherRAILROAD MEDICARE
FL580001929OtherRAILROAD MEDICARE
FL078478800Medicaid