ROY RAYMOND GIBSON (NPI# 1104816743) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104816743 |
| Entity Type | Individual |
| Full Name | ROY RAYMOND GIBSON |
| Credential | O.D. |
| Practice Address |
4949 S 900 W Riverdale UT 84405-3777 |
| Mailing Address |
5690 S 3750 W Roy UT 84067-8161 |
| Practice Telephone | 8016210480 |
| Practice Fax Number | 8016123485 |
| Mailing Telephone | 8019854141 |
| Mailing Fax Number | 8019854242 |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | X |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 152W00000X | Optometrist | 1130288904 | UT | Eye and Vision Services Providers |
| Y | 152W00000X | Optometrist | 1130289934 | UT | Eye and Vision Services Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UT | FIRST HEALTH NETWORK | 1737499 | 01 |
| UT | DMBA | 589803 | 01 |
| UT | CAQH | 11445324 | 01 |
| UT | PEHP | 81820 | 01 |
| Street Address |
4949 S 900 W |
| City | RIVERDALE |
| State | UT |
| Zip Code | 84405-3777 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245329226 | Sam's Club Optical | Technician/Technologist | 4949 S 900 W, Riverdale, UT 84405-3777 | 2006-10-11 |
| 1053339804 | Sams West Inc | Durable Medical Equipment & Medical Supplies | 4949 S 900 W, Riverdale, UT 84405-3777 | 2006-07-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669028171 | Alyssa House | Behavioral Analyst | 4933 1500 West #110, Riverdale, UT 84405 | 2019-08-12 |
| 1518525989 | Petersen Farms Assisted Living & Memory Care | Assisted Living Facility | 6980 S. 475 E., South Weber, UT 84405 | 2019-05-31 |
| 1376038141 | National Vision, Inc. | Technician/Technologist | 821 West Riverdale Road, Riverdale, UT 84405 | 2018-06-25 |
| 1194218461 | South Weber City | Ambulance | 7365 S 1375 E, South Weber, UT 84405 | 2018-06-12 |
| 1528572682 | Sandra Jo Scott | Dental Hygienist | 264 W Ridgeline Dr, Washington Terrace, UT 84405 | 2017-11-28 |
| 1376079061 | Loretta Shupe | Registered Nurse | 5319 S 500 E, Ogden, UT 84405 | 2017-05-02 |
| 1134661374 | Randy Ferrin | Registered Nurse | 5697 Maplewood Drive, South Ogden, UT 84405 | 2016-11-04 |
| 1871046284 | Karla Rosen | Counselor | 5202 S. Freeway Park Dr., Riverdale, UT 84405 | 2016-08-02 |
| 1053784520 | Jenifer Rebecca Nilson Smith | Physical Therapist | 5648 S. Adams Ave, Washington Terrace, UT 84405 | 2015-11-05 |
| 1972976454 | Jenniferlyn Fletcher | Physical Therapy Assistant | 5648 South Adams Ave, Washington Terrace, UT 84405 | 2015-11-05 |
| Find all providers in zip 84405 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962989632 | Alyson Escalona | Optometrist | 92 Nj-23, Riverdale, NJ 07457 | 2018-07-25 |
| 1669852083 | Rajini Seevaratnam | Optometrist | 5711 Sarvis Ave Ste 402, Riverdale, MD 20737-1365 | 2015-06-01 |
| 1093999237 | Lisa Valerie Gaines-smith | Optometrist | 48 State Route 23 North, Riverdale, NJ 07457-1602 | 2007-12-24 |
| 1508922717 | Gail Ann Petersen | Optometrist | 6603 Riverdale Rd, Riverdale, MD 20737-2908 | 2006-12-29 |
| 1861439119 | Fred Osaretin Osayi | Optometrist | 7583 Highway 85, Riverdale, GA 30274-3438 | 2006-06-02 |
| 1710456975 | Eye Pros of Ogden | Optometrist | 4115 Riverdale Rd, Riverdale, UT 84405-3509 | 2018-11-16 |
| 1922520501 | Haley Penrod | Optometrist | 131 Upper Riverdale Rd Sw, Riverdale, GA 30274-2540 | 2017-07-14 |
| 1801316138 | Boster Vision, LLC | Optometrist | 4848 S 900 W, Riverdale, UT 84405-3726 | 2017-06-27 |
| 1962886986 | Christine Elizabeth Corrente | Optometrist | 92 Route 23 North, Suite E, Riverdale, NJ 07457 | 2015-07-20 |
| 1508147612 | Niketha Ajodha | Optometrist | 7050 Highway 85, Riverdale, GA 30274-2946 | 2011-09-01 |
| Find all providers in RIVERDALE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.