# KOKOPELLI EYE CARE SURGERY CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205858875
- **Authorized official:** MICHAEL LEE HAM MD (OWNER/PRESIDENT)
- **Authorized official phone:** (928) 775-5606

## Contact information

- **Practice address:** 2820 N GLASSFORD HILL RD, PRESCOTT VALLEY, AZ 86314-1242
- **Practice address phone:** (928) 775-5606
- **Practice address fax:** (928) 772-4999
- **Mailing address:** 2820 N GLASSFORD HILL RD, 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 | OSC 0078 | AZ | Yes |

## Other

- **Enumeration date:** 07/24/2006
- **Last updated:** 07/10/2007