Provider Demographics
NPI:1144522962
Name:RUBIO, VICTOR A
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:A
Last Name:RUBIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14476 HORIZON BLVD STE L
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-8579
Mailing Address - Country:US
Mailing Address - Phone:915-239-5605
Mailing Address - Fax:915-533-2468
Practice Address - Street 1:7132 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3651
Practice Address - Country:US
Practice Address - Phone:915-587-8667
Practice Address - Fax:915-533-2468
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
163732156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
163732OtherCETIFIED OPTICIAN ABOC