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NPI Code Detail

MEDICARE: KOKOPELLI EYE CARE PC

MEDICARE: KOKOPELLI EYE CARE PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies26357AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1669975157
Entity Type Code : Organization
Provider Name (Legal Business Name) : KOKOPELLI EYE CARE PC
Provider Business Mailing Address
First Line : 2820 N GLASSFORD HILL RD
Second Line :
City : PRESCOTT VALLEY
State : AZ
Zip : 86314-1242
Country : US
Telephone Number : 928-771-9000
Fax Number : 928-759-9902
Provider Business Practice Location Address
First Line : 16605 E PALISADES BLVD STE 152
Second Line :
City : FOUNTAIN HILLS
State : AZ
Zip : 85268-3717
Country : US
Telephone Number : 844-565-6393
Fax Number : 844-329-5656
Authorized Official
Title or Position : PRESIDENT
Name : DR. MICHAEL LEE HAM
Credential : MD
Telephone Number : 928-775-5606
Provider Enumeration Date : 03/12/2018
Last Update Date : 09/05/2019

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Directions to “KOKOPELLI EYE CARE PC ” Practice Location

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