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The effective use of geospatial data and technologies to collect, manage, analyze, model and visualize geographic data has great potential to improve data driven decision-making for immunization programs. This article presents A Theory of Change for the use of geospatial technologies for immunization programming, a framework to illustrate the ways that geospatial data and technologies can contribute to improved immunization outcomes and have a positive impact on childhood immunization coverage rates in low- and middle-income countries. The Theory of Change is the result of a review of the state of the evidence and literature, consultation with implementers, donors, immunization and geospatial technology experts and a review of country implementation experiences. The framework illustrates how the effective use of geospatial data and technologies can help immunization programs realize improvements in the number of children immunized by producing reliable estimates of target populations, identifying chronically missed settlements and locations with the highest number of zero-dose and under-immunized children and guiding immunization managers with solutions to optimize resource distribution and location of health services. Through these direct effects on service delivery, geospatial data and technologies can contribute to overall health system strengthening with equity in immunization coverage. The Theory of Change presented here may serve as a guide for country program managers, implementers, donors and other stakeholders to better understand how geospatial tools can support immunization programs and facilitate integrated service planning and equitable delivery through the unifying role of geography and geospatial data.