Provider Demographics
NPI:1366182255
Name:CANYON OFP, PLLC
Entity type:Organization
Organization Name:CANYON OFP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:WINGSY
Authorized Official - Last Name:VARGASON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-901-8749
Mailing Address - Street 1:490 E SUNNYRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6542
Mailing Address - Country:US
Mailing Address - Phone:208-901-8749
Mailing Address - Fax:
Practice Address - Street 1:4405 E FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-3113
Practice Address - Country:US
Practice Address - Phone:208-285-6282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive SurgeryGroup - Single Specialty