Individual
ROY RAYMOND GIBSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
4949 S 900 W, RIVERDALE, UT 84405-3777
(801) 621-0480
(801) 612-3485
Mailing address
5690 S 3750 W, ROY, UT 84067-8161
(801) 985-4141
(801) 985-4242
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
1130288904
UT
152W00000X
Optometrist
Primary
1130289934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11445324
CAQH
UT
01
—
1737499
FIRST HEALTH NETWORK
UT
01
—
589803
DMBA
UT
01
—
81820
PEHP
UT
Enumeration date
10/25/2005
Last updated
07/08/2007
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