Organization
KOKOPELLI EYE CARE SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL LEE HAM MD (OWNER/PRESIDENT)
(928) 775-5606
Entity
Organization
Contact information
Practice address
2820 N GLASSFORD HILL RD, PRESCOTT VALLEY, AZ 86314-1242
(928) 775-5606
(928) 772-4999
Mailing address
2820 N GLASSFORD HILL RD, PRESCOTT VALLEY, AZ 86314-1242
(928) 775-5606
(928) 772-4999
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OSC 0078
AZ
Other
Enumeration date
07/24/2006
Last updated
07/10/2007
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