Roy Raymond Gibson, O.D.
Individual provider Active NPI Optometrist · Riverdale, UT
NPI 1104816743 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1104816743
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 1130289934 (UT)
- Practice address
- 4949 S 900 W
Riverdale, UT 84405-3777 - Phone
- (801) 621-0480
- Fax
- (801) 612-3485
- NPI assigned
- Oct 25, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- University of Houston - College of Optometry, 1985
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Eye Pros of Layton LLC
Eye Pros of Ogden
Practice addresses (Care Compare)
1986 N Hill Field Rd
Layton, UT 84041-2109
Phone (833) 776-2020
4115 Riverdale Rd
Riverdale, UT 84405-3509
Phone (833) 776-2020
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Cataract surgery | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040514001008 | UT | Practitioner - Optometry | 5294725834 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1130288904 | UT | MD | Optometrist |
Practice roles (3 of 5)
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Pros of Logan LLC | Optometrist | Current |
Accepting new patients |
| Eye Pros of Ogden | Optometrist | Current |
Accepting new patients |
| Eye Pros of Layton LLC | Optometrist | Current |
Accepting new patients |
Locations
3485 N Cole Rd
Unit 45479
Boise, ID 83711
1986 N Hill Field Rd
Layton, UT 84041
Phone (208) 297-7019
1475 N Main St
Ste 103
Logan, UT 84341
Phone (208) 297-7019
4115 Riverdale Rd
Riverdale, UT 84405
Phone (208) 297-7019
Networks
- UT PPO D-SNP
- UT PPO
Interoperability endpoints
- roy.gibson@direct.revolutionehr.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1130289934 | UT | Yes |
| Optometrist | 152W00000X | 1130288904 | UT |
Addresses
Primary practice location
4949 S 900 W
Riverdale, UT 84405-3777
Mailing address
5690 S 3750 W
Roy, UT 84067-8161
Phone (801) 985-4141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1737499 | Other | UT | FIRST HEALTH NETWORK |
| 589803 | Other | UT | DMBA |
| 11445324 | Other | UT | CAQH |
| 81820 | Other | UT | PEHP |
Other providers in Riverdale, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.