Healthcare Provider Details

I. General information

NPI: 1962467753
Provider Name (Legal Business Name): JEFF RABIN O.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9725 DATAPOINT DR
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

9725 DATAPOINT DR
SAN ANTONIO TX
78229-2384
US

V. Phone/Fax

Practice location:
  • Phone: 210-283-6800
  • Fax: 210-283-6825
Mailing address:
  • Phone: 210-283-6800
  • Fax: 210-283-6825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3108T
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number7314
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8044
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: