Kokopelli Eye Care PC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

26357 Issued in AZ

Legal business name

KOKOPELLI EYE CARE PC

Doing business as

Kokopelli Eye Institute

Practice address

25 W Yavapai St
Wickenburg, AZ 85390-3280

Phone

(844) 565-6393

Fax

(844) 329-5656

NPI assigned

Mar 13, 2018

Organization subpart

No

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

Authorized official

Name

Michael Lee Ham, MD

Title

President

Phone

(928) 775-5606

Specialties & licenses 1

Addresses

Other names 1

• Kokopelli Eye Institute Doing business as

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

{
    "created_epoch": "1520899200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520899200000",
    "number": "1174026546",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2820 N GLASSFORD HILL RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863141242",
            "telephone_number": "928-771-9000",
            "fax_number": "928-759-9902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 W YAVAPAI ST",
            "city": "WICKENBURG",
            "state": "AZ",
            "postal_code": "853903280",
            "telephone_number": "844-565-6393",
            "fax_number": "844-329-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOKOPELLI EYE CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-13",
        "last_updated": "2018-03-13",
        "status": "A",
        "authorized_official_last_name": "HAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "928-775-5606",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "AZ",
            "license": "26357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kokopelli Eye Institute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Keshia Jones, PHARM. D.
• Troy Conlin Jones, D.M.D.
• Diane Elizabeth Juillard, DO
• KC'S Home Healthcare LLC
• Edward F Kirk, D.D.S.
• Oksana Konko
• Todd M. Kravetz, M.D.
• Carrie Kray, LCSW
• Laboratory Corporation of America
• Christopher Thomas Larson

• Durable Medical Equipment & Medical Supplies in Wickenburg, AZ
• Providers in Wickenburg, AZ by specialty
• Durable Medical Equipment & Medical Supplies in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2018; 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.