Provider Demographics
NPI:1982817193
Name:RUBIN, JACK (OD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
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 1:11406 SAN JOSE BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7963
Mailing Address - Country:US
Mailing Address - Phone:904-260-3839
Mailing Address - Fax:904-260-7879
Practice Address - Street 1:11406 SAN JOSE BLVD
Practice Address - Street 2:STE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-7963
Practice Address - Country:US
Practice Address - Phone:904-260-3839
Practice Address - Fax:904-260-7879
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2010-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1114152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management