1235124728 NPI number — CANYON EYE ASSOCIATES, INC.

Table of content: (NPI 1235124728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235124728 NPI number — CANYON EYE ASSOCIATES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANYON EYE ASSOCIATES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235124728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 TAYLOR STATION RD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43213-4400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-866-9134
Provider Business Mailing Address Fax Number:
614-866-6964

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 TAYLOR STATION RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43213-4400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-866-9134
Provider Business Practice Location Address Fax Number:
614-866-6964
Provider Enumeration Date:
09/12/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALWOOD
Authorized Official First Name:
CRYSTAL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
614-866-9134

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 31089242493-00 . This is a "BUREAU OF WORKERS COMP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2015616 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000160740 . This is a "ANTHEM BC BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".