Organization
KOKOPELLI EYE CARE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL HAM MD (PRESIDENT)
(928) 775-5606
Entity
Organization
Contact information
Practice address
412 WHIPPLE ST, PRESCOTT, AZ 86301-1712
(928) 771-9000
(928) 771-9460
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
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
AZ26357
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1229680002
MEDICARE SUPPLIER NUMBER
AZ
Enumeration date
05/19/2008
Last updated
08/28/2014
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