Provider Demographics
NPI:1043489420
Name:GOLD CANYON EYE CENTER, PLLC
Entity Type:Organization
Organization Name:GOLD CANYON EYE CENTER, PLLC
Other - Org Name:GOLD CANYON EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHENG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-474-2020
Mailing Address - Street 1:6900 E US HIGHWAY 60
Mailing Address - Street 2:118
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-7443
Mailing Address - Country:US
Mailing Address - Phone:480-474-2020
Mailing Address - Fax:480-474-8787
Practice Address - Street 1:6900 E US HIGHWAY 60
Practice Address - Street 2:118
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-7443
Practice Address - Country:US
Practice Address - Phone:480-474-2020
Practice Address - Fax:480-474-8787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO9435Medicare PIN