Provider Demographics
NPI:1235124728
Name:CANYON EYE ASSOCIATES, INC.
Entity Type:Organization
Organization Name:CANYON EYE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:H
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-866-9134
Mailing Address - Street 1:150 TAYLOR STATION ROAD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-4440
Mailing Address - Country:US
Mailing Address - Phone:614-866-9134
Mailing Address - Fax:614-866-6964
Practice Address - Street 1:150 TAYLOR STATION ROAD
Practice Address - Street 2:SUITE 150
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-4440
Practice Address - Country:US
Practice Address - Phone:614-866-9134
Practice Address - Fax:614-866-6964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH31089242493-00OtherBUREAU OF WORKERS COMP
OH000000160740OtherANTHEM BC BS
OH2015616Medicaid
OH31089242493-00OtherBUREAU OF WORKERS COMP
CE8240Medicare UPIN