Healthcare Provider Details

I. General information

NPI: 1356659163
Provider Name (Legal Business Name): JAMES D RUBIN O.D. PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2010
Last Update Date: 09/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2920 NE 60TH ST
GLADSTONE MO
64119-2031
US

IV. Provider business mailing address

2920 NE 60TH ST
GLADSTONE MO
64119-2031
US

V. Phone/Fax

Practice location:
  • Phone: 816-452-3937
  • Fax: 816-455-2428
Mailing address:
  • Phone: 816-452-3937
  • Fax: 816-455-2428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberT02390
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberT02390
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberT02390
License Number StateMO
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberT02390
License Number StateMO
# 5
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License NumberT02390
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberT02390
License Number StateMO
# 7
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02390
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. JAMES D RUBIN
Title or Position: DR / OWNER
Credential: O.D.
Phone: 816-452-3937