Provider Demographics
NPI:1134415896
Name:RUBIO, MARCO A (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:A
Last Name:RUBIO
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:69 PROSPECT HILL RD
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06088-3600
Mailing Address - Country:US
Mailing Address - Phone:860-623-7910
Mailing Address - Fax:860-627-6433
Practice Address - Street 1:69 PROSPECT HILL RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06088-3600
Practice Address - Country:US
Practice Address - Phone:860-623-7910
Practice Address - Fax:860-627-6433
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001627156FX1202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician