Provider Demographics
NPI:1861388464
Name:RUBALCAVA, JACQUELYN IVETTE (OD)
Entity type:Individual
Prefix:DR
First Name:JACQUELYN
Middle Name:IVETTE
Last Name:RUBALCAVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 E LAMAR ST
Mailing Address - Street 2:
Mailing Address - City:PALESTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75801-3709
Mailing Address - Country:US
Mailing Address - Phone:903-948-8772
Mailing Address - Fax:
Practice Address - Street 1:501 E KOLSTAD ST
Practice Address - Street 2:
Practice Address - City:PALESTINE
Practice Address - State:TX
Practice Address - Zip Code:75801-2310
Practice Address - Country:US
Practice Address - Phone:903-723-3250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11389TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist