Provider Demographics
NPI:1275624751
Name:GAYER, THOMAS E (OD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:E
Last Name:GAYER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5770 S 250 E
Mailing Address - Street 2:SUITE 410
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-8100
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-9502
Practice Address - Street 1:5770 S 250 E
Practice Address - Street 2:SUITE 410
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-8100
Practice Address - Country:US
Practice Address - Phone:801-314-4420
Practice Address - Fax:801-314-4421
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT267785-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1275624751Medicaid
UT1275624751Medicaid
UT000010983Medicare PIN