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) 775-5606
Entity
Organization
Contact information
Practice address
16605 E PALISADES BLVD STE 152, FOUNTAIN HILLS, AZ 85268-3717
(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
26357
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
030341
—
AZ
Enumeration date
03/12/2018
Last updated
09/05/2019
Update your record
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