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General NPI Number Information
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NPI Number | 1144731795
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Entity Type | Organization
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Legal Business Name | GREGORY ALAN KUBO, O.D., APC
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Dates
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Enumeration Date | 10/22/2017
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Last Update Date | 10/22/2017
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Provider Practice Location Address
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Address Line | 1319 S HARBOR BLVD
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City | FULLERTON
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State | CA
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Zip | 92832-3001
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Country | US
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Telephone | 714-525-3330
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 S HARBOR BLVD
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City | FULLERTON
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State | CA
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Zip | 92832-3001
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Country | US
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Telephone | 714-525-3330
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | GREGORY A. KUBO X
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Credential | OD
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Telephone | 714-469-5977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9278
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License Number State | CA
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