Provider Demographics
NPI:1558550913
Name:GUMMOW, ALAN BRANT (OD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:BRANT
Last Name:GUMMOW
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 1:307 N 300 W
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KAYSVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84037-1852
Mailing Address - Country:US
Mailing Address - Phone:801-444-9977
Mailing Address - Fax:801-444-2610
Practice Address - Street 1:307 N 300 W
Practice Address - Street 2:SUITE 302
Practice Address - City:KAYSVILLE
Practice Address - State:UT
Practice Address - Zip Code:84037-1852
Practice Address - Country:US
Practice Address - Phone:801-444-9977
Practice Address - Fax:801-444-2610
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6675342-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist