Provider Demographics
NPI:1093868572
Name:CANYONVIEW FAMILY EYE CARE LLC
Entity Type:Organization
Organization Name:CANYONVIEW FAMILY EYE CARE LLC
Other - Org Name:KARL B CZIRR OD, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:B
Authorized Official - Last Name:CZIRR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-737-2010
Mailing Address - Street 1:4309 W 27TH PLACE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99338
Mailing Address - Country:US
Mailing Address - Phone:509-737-2010
Mailing Address - Fax:509-737-2012
Practice Address - Street 1:4309 W 27TH PLACE
Practice Address - Street 2:SUITE 102
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99338
Practice Address - Country:US
Practice Address - Phone:509-737-2010
Practice Address - Fax:509-737-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3567TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2032530Medicaid
WA5856550001Medicare NSC
WA2032530Medicaid