NPIMap

Organization Active NPI

Kokopelli Eye Care Surgery Center

  • Ambulatory Surgical Clinic/Center
  • Prescott Valley, AZ
National Provider Identifier
1205858875
Registry record updated Jul 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
OSC 0078 Issued in AZ
Legal business name
KOKOPELLI EYE CARE SURGERY CENTER
Practice address
2820 N Glassford Hill Rd
Prescott Valley, AZ 86314-1242
Phone
(928) 775-5606
Fax
(928) 772-4999
NPI assigned
Jul 24, 2006
Last updated
Jul 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2007

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

Authorized official

Name
Michael Lee Ham, MDNPI 1750385647
Title
Owner/President
Phone
(928) 775-5606

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X OSC 0078 AZ Primary

Addresses

Primary practice location

2820 N Glassford Hill Rd
Prescott Valley, AZ 86314-1242

Mailing address

2820 N Glassford Hill Rd
Prescott Valley, AZ 86314-1242
Phone (928) 775-5606

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1205858875",
    "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": "928-775-5606",
            "fax_number": "928-772-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2820 N GLASSFORD HILL RD",
            "city": "PRESCOTT VALLEY",
            "state": "AZ",
            "postal_code": "863141242",
            "telephone_number": "928-775-5606",
            "fax_number": "928-772-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KOKOPELLI EYE CARE SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-24",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "HAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "928-775-5606",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "AZ",
            "license": "OSC 0078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prescott Valley, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 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.