MEDICARE: INTERNATIONAL EYE ASSOCIATES P.A.

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	207W00000X	Ophthalmology Physician	ME0047655	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972524023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL EYE ASSOCIATES P.A.

Provider Business Mailing Address
First Line	:	1545 HAND AVENUE
Second Line	:	SUITE B3
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1140
Country	:	US
Telephone Number	:	386-673-3939
Fax Number	:	386-677-5374

Provider Business Practice Location Address
First Line	:	1545 HAND AVENUE
Second Line	:	SUITE B3
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1140
Country	:	US
Telephone Number	:	386-673-3939
Fax Number	:	386-677-5374

Authorized Official
Title or Position	:	DOCTOR/OWNER
Name	:	DR. MARK S. RUBIN
Credential	:	M.D.
Telephone Number	:	386-673-3939

Provider Enumeration Date	:	07/22/2006
Last Update Date	:	05/13/2009

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