Provider Demographics
NPI:1518264050
Name:CANYON EYE CENTER, P.C.
Entity Type:Organization
Organization Name:CANYON EYE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-485-5831
Mailing Address - Street 1:3895 W 7800 S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84088-5617
Mailing Address - Country:US
Mailing Address - Phone:801-948-4442
Mailing Address - Fax:801-987-8462
Practice Address - Street 1:3895 W 7800 S
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-5617
Practice Address - Country:US
Practice Address - Phone:801-948-4442
Practice Address - Fax:801-987-8462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-18
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6825165-1205207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty