MEDICARE: DR. JEFFREY M. RUBIN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV003916	NY
2	152WC0802X	Corneal and Contact Management Optometrist	TUV003916	NY
3	152WV0400X	Vision Therapy Optometrist	TUV003916	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	397349	OTHER	NY	UNITED HEALTHCARE
2	5118769	OTHER	NY	CIGNA
3	90580	OTHER	NY	AETNA
4	C31061	OTHER		BLUE CROSS
5	2C9484	OTHER	NY	HEALTHNET
6	901131	OTHER	NY	BLOCK VISION
7	P1068808	OTHER	NY	OXFORD

General Provider Information

NPI Number	:	1396749651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY M. RUBIN O.D.

Provider Business Mailing Address
First Line	:	55 OLD TURNPIKE RD
Second Line	:	STE 201
City	:	NANUET
State	:	NY
Zip	:	10954-2450
Country	:	US
Telephone Number	:	845-623-3500
Fax Number	:	845-623-2223

Provider Business Practice Location Address
First Line	:	55 OLD TURNPIKE RD
Second Line	:	STE 201
City	:	NANUET
State	:	NY
Zip	:	10954-2450
Country	:	US
Telephone Number	:	845-623-3500
Fax Number	:	845-623-2223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	12/07/2010

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Directions to “ DR. JEFFREY M. RUBIN O.D.” Practice Location

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