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General NPI Number Information
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NPI Number | 1669975157
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Entity Type | Organization
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Legal Business Name | KOKOPELLI EYE CARE PC
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Dates
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Enumeration Date | 03/12/2018
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 16605 E PALISADES BLVD STE 152
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-3717
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Country | US
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Telephone | 844-565-6393
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Fax | 844-329-5656
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Provider Business Mailing Address
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Address Line | 2820 N GLASSFORD HILL RD
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City | PRESCOTT VALLEY
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State | AZ
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Zip | 86314-1242
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Country | US
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Telephone | 928-771-9000
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Fax | 928-759-9902
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL LEE HAM
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Credential | MD
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Telephone | 928-775-5606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 26357
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License Number State | AZ
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