Healthcare Provider Details

I. General information

NPI: 1871989111
Provider Name (Legal Business Name): M&M EYE INSTITUTE PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 WILLOW CREEK RD
PRESCOTT AZ
86301-1108
US

IV. Provider business mailing address

3192 WILLOW CREEK RD
PRESCOTT AZ
86301-6610
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 TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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