# KOKOPELLI EYE CARE PC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** KOKOPELLI EYE CARE, PC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1114140019
- **Legal business name:** KOKOPELLI EYE CARE, PC
- **Authorized official:** MR. MICHAEL L HAM MD (PRESIDENT)
- **Authorized official phone:** (928) 771-9000

## Contact information

- **Practice address:** 412 WHIPPLE ST, PRESCOTT, AZ 86301-1712
- **Practice address phone:** (928) 771-9000
- **Practice address fax:** (928) 771-9460
- **Mailing address:** 2820 N GLASSFORD HILL RD, SUITE 101, PRESCOTT VALLEY, AZ 86314-1242
- **Mailing address phone:** (928) 775-5606
- **Mailing address fax:** (928) 772-4999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | OSC3634 | AZ | Yes |

## Other

- **Enumeration date:** 04/10/2007
- **Last updated:** 11/16/2007