Provider Demographics
NPI:1801942271
Name:RUBIN, HARVEY (OPTICIANS)
Entity type:Individual
Prefix:
First Name:HARVEY
Middle Name:
Last Name:RUBIN
Suffix:
Gender:M
Credentials:OPTICIANS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 ROBERT SMALLS PKWY
Mailing Address - Street 2:SUITE # 14
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29906-4237
Mailing Address - Country:US
Mailing Address - Phone:843-522-0088
Mailing Address - Fax:843-522-2187
Practice Address - Street 1:330 ROBERT SMALLS PKWY
Practice Address - Street 2:SUITE # 14
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29906-4237
Practice Address - Country:US
Practice Address - Phone:843-522-0088
Practice Address - Fax:843-522-2187
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC244156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDV2444Medicaid
SCDV2444Medicaid