Healthcare Provider Details

I. General information

NPI: 1538042767
Provider Name (Legal Business Name): GINA KUBESH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

161 HAMPTON POINT DR STE 3
SAINT AUGUSTINE FL
32092-3058
US

IV. Provider business mailing address

250 ASCEND CIR APT 8301
SAINT JOHNS FL
32259-4176
US

V. Phone/Fax

Practice location:
  • Phone: 904-204-3345
  • Fax:
Mailing address:
  • Phone: 207-357-9218
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6785
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: