Gustaf Isaac Gibson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

5823517-9934 Issued in UT

Practice address

145 W Cache Valley Blvd
Logan, UT 84341-8473

Phone

(435) 787-9273

Fax

(435) 787-9275

NPI assigned

Jan 17, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

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, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1137456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1215917307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "435 W 1140 N",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843416994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 W CACHE VALLEY BLVD",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843418473",
            "telephone_number": "435-787-9273",
            "fax_number": "435-787-9275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIBSON",
        "first_name": "GUSTAF",
        "middle_name": "ISAAC",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-17",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OR",
            "license": "2994T",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "5823517-9934",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gessner Peterson House Calls Inc
• Roueida Ghadban, PHD CLINICAL PSYCHOL
• Brenda Ann Gibbons
• Jennie Grace Gibbons
• Kierra Gibbons
• Jamielyn Ekiko Gibson
• Tanya Gibson, CSW, MSW
• John Giles
• Noel Carson Gill, PH.D.
• Sandra Laing Gillam, SANDRA GILLAM

• All providers in Logan, UT
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; 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.