Organization
KOKOPELLI EYE CARE PC
Active
Other names
Kokopelli Eye Institute
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL LEE HAM MD (PRESIDENT)
(928) 771-9000
Entity
Organization
Contact information
Practice address
9151 W THUNDERBIRD RD STE 104, PEORIA, AZ 85381-4906
(844) 565-6393
(844) 329-5656
Mailing address
2820 N GLASSFORD HILL RD, PRESCOTT VALLEY, AZ 86314-1242
(928) 771-9000
(928) 759-9902
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030341
—
AZ
Enumeration date
08/06/2019
Last updated
08/06/2019
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