Healthcare Provider Details

I. General information

NPI: 1235124728
Provider Name (Legal Business Name): CANYON EYE ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 TAYLOR STATION RD
COLUMBUS OH
43213-4400
US

IV. Provider business mailing address

245 TAYLOR STATION RD STE 150
COLUMBUS OH
43213-4400
US

V. Phone/Fax

Practice location:
  • Phone: 614-866-9134
  • Fax: 614-866-6964
Mailing address:
  • Phone: 614-866-9134
  • Fax: 614-866-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL E ALWOOD
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 614-866-9134