MEDICARE: EYE HEALTH & VISION CENTER PA

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	OPC1776	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	580001929	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	AG551	OTHER		PTAN

General Provider Information

NPI Number	:	1659492502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE HEALTH & VISION CENTER PA

Provider Business Mailing Address
First Line	:	107 SHAMROCK BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-1630
Country	:	US
Telephone Number	:	941-493-3763
Fax Number	:	941-492-9179

Provider Business Practice Location Address
First Line	:	107 SHAMROCK BLVD
Second Line	:
City	:	VENICE
State	:	FL
Zip	:	34293-1630
Country	:	US
Telephone Number	:	941-493-3763
Fax Number	:	941-492-9179

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID MARK RUBIN
Credential	:	O.D.
Telephone Number	:	941-493-3763

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	08/19/2015

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Directions to “EYE HEALTH & VISION CENTER PA ” Practice Location

Language	Start Address	Practice Location

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