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General NPI Number Information
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NPI Number | 1659492502
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Entity Type | Organization
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Legal Business Name | EYE HEALTH & VISION CENTER PA
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 107 SHAMROCK BLVD
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City | VENICE
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State | FL
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Zip | 34293-1630
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Country | US
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Telephone | 941-493-3763
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Fax | 941-492-9179
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Provider Business Mailing Address
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Address Line | 107 SHAMROCK BLVD
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City | VENICE
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State | FL
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Zip | 34293-1630
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Country | US
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Telephone | 941-493-3763
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Fax | 941-492-9179
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID MARK RUBIN
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Credential | O.D.
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Telephone | 941-493-3763
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC1776
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License Number State | FL
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