=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083788335
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FRANK E RUBIN O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2006
-----------------------------------------------------
Last Update Date | 05/02/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1962 DEMPSTER ST
-----------------------------------------------------
City | EVANSTON
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60202-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-475-3937
-----------------------------------------------------
Fax | 847-475-9572
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3918 ENFIELD AVE
-----------------------------------------------------
City | SKOKIE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60076-2222
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-475-3937
-----------------------------------------------------
Fax | 847-475-9572
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 046007781
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------