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General NPI Number Information
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NPI Number | 1689871667
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Entity Type | Organization
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Legal Business Name | JOHN R MARKHAM PC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 04/01/2016
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Provider Practice Location Address
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Address Line | 1680 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-1108
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Country | US
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Telephone | 928-778-3950
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Fax | 928-778-3999
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Provider Business Mailing Address
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Address Line | 3192 WILLOW CREEK RD
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City | PRESCOTT
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State | AZ
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Zip | 86301-6610
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Country | US
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Telephone | 928-778-3950
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Fax | 928-778-3999
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN ROBERT MARKHAM
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Credential | OD
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Telephone | 928-778-3950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 142
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1885
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License Number State | AZ
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