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General NPI Number Information
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NPI Number | 1992357560
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Entity Type | Individual
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Provider Name | ANGELINA GAVEL-RUKHA OD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2019
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 450 STATE ROAD 13 N STE 107
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City | ST JOHNS
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State | FL
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Zip | 32259-3861
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Country | US
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Telephone | 904-287-3678
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Fax | 904-287-3386
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Provider Business Mailing Address
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Address Line | 8614 WESTWOOD CENTER DR FL 9
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City | VIENNA
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State | VA
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Zip | 22182-2442
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 5375
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3115
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC5745
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License Number State | FL
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