Healthcare Provider Details

I. General information

NPI: 1932540119
Provider Name (Legal Business Name): JOHN R MARKHAM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2013
Last Update Date: 07/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3223 N WINDSONG DR
PRESCOTT VALLEY AZ
86314-1222
US

IV. Provider business mailing address

1680 WILLOW CREEK RD
PRESCOTT AZ
86301-1108
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number StateAZ

VIII. Authorized Official

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