Healthcare Provider Details

I. General information

NPI: 1316332596
Provider Name (Legal Business Name): M & M EYE INSTITUTE, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

399 W PALOMINO RD
CHINO VALLEY AZ
86323-5648
US

IV. Provider business mailing address

3192 WILLOW CREEK RD
PRESCOTT AZ
86301-6610
US

V. Phone/Fax

Practice location:
  • Phone: 928-636-5504
  • Fax: 928-636-0780
Mailing address:
  • Phone: 928-778-3950
  • Fax: 928-778-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MARKHAM
Title or Position: OWNER
Credential: DO
Phone: 928-778-3950