Individual
DR. GAVIN LANE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
34 S MAIN ST, BRIGHAM CITY, UT 84302-2527
(435) 723-2485
(435) 723-5840
Mailing address
110 E 750 N, MANTUA, UT 84324-4343
(435) 730-3998
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12753476-9934
UT
Other
Enumeration date
06/10/2020
Last updated
01/11/2024
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