Kokopelli Eye Care PC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

OSC3634 Issued in AZ

Legal business name

KOKOPELLI EYE CARE PC

Practice address

412 Whipple St
Prescott, AZ 86301-1712

Phone

(928) 771-9000

Fax

(928) 771-9460

NPI assigned

Apr 10, 2007

Organization subpart

Yes

Parent organization

KOKOPELLI EYE CARE, PCAs reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Michael L Ham, MD

Title

President

Phone

(928) 771-9000

Specialties & licenses 1

Addresses

Part of

Kokopelli Eyecare PC

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1195171200000",
    "number": "1114140019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 N GLASSFORD HILL RD",
            "address_2": "SUITE 101",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863141242",
            "telephone_number": "928-775-5606",
            "fax_number": "928-772-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "412 WHIPPLE ST",
            "city": "PRESCOTT",
            "state": "AZ",
            "postal_code": "863011712",
            "telephone_number": "928-771-9000",
            "fax_number": "928-771-9460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOKOPELLI EYE CARE PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KOKOPELLI EYE CARE, PC",
        "enumeration_date": "2007-04-10",
        "last_updated": "2007-11-16",
        "status": "A",
        "authorized_official_last_name": "HAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-771-9000",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AZ",
            "license": "OSC3634",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matthew Charles Knoth, PHARMD, BCPS, BCNSP
• Lisa Mae Knowlton, NP-C
• Laurie Anne Knutsen, OTR
• Leanne J Kocemba, NP
• Stacey L Kocis, MT-10198
• Kokopelli Eye Care PC
• Kokoro II LTD
• Calie Kolb
• Carolyn R Kolb, NP-C
• Michele A Kolb, R.N.

• Ambulatory Surgical Clinic/Center in Prescott, AZ
• Providers in Prescott, AZ by specialty
• Ambulatory Surgical Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.