Gavin Lane Johnson, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

12753476-9934 Issued in UT

Practice address

34 S Main St
Brigham City, UT 84302-2527

Phone

(435) 723-2485

Fax

(435) 723-5840

NPI assigned

Jun 10, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Pacific University - College of Optometry, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Networks

• UT PPO D-SNP
• UT PPO

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gavin L Johnson OD LLC

  • Optometrist
  • Brigham City, UT
  • NPI 1699478545
  Medicare reassignment NPD Authorized official
• Larry D Terry a Professional Corporation

  • Optometrist
  • Brigham City, UT
  • NPI 1811217383
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704931200000",
    "number": "1194340745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 E 750 N",
            "city": "MANTUA",
            "state": "UT",
            "postal_code": "843244343",
            "telephone_number": "435-730-3998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34 S MAIN ST",
            "city": "BRIGHAM CITY",
            "state": "UT",
            "postal_code": "843022527",
            "telephone_number": "435-723-2485",
            "fax_number": "435-723-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "GAVIN",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-10",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "12753476-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christoper Steven Johnson
• Courtney Lee Johnson
• Craig Alexander Johnson, D.C.
• Daniel J Johnson, DO
• David Jackson Johnson
• McKenna Higley Johnson
• Richard Scott Johnson, LCSW
• Rylee Johnson
• Baylee Jones
• Jason Scott Jones

• Optometrist in Brigham City, UT
• Providers in Brigham City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.