Basic Information
| Provider Information | |||||||||
| NPI: | 1225094550 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MARKHAM | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3192 WILLOW CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863016610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287783950 | ||||||||
| FaxNumber: | 9287783999 | ||||||||
| Practice Location | |||||||||
| Address1: | 1680 WILLOW CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863011108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287783950 | ||||||||
| FaxNumber: | 9287783999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 04/20/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 142 | AZ | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 033176 | 05 | AZ | MEDICAID | 153165 | 01 | RAN & AMN | OTHER | 5858351 | 01 | AETNA | OTHER | 033176 | 01 | AZ | AHCCCS | OTHER | 866291-9714 | 01 | HUMANA | OTHER | 1263119 | 01 | AZ | MERCYCARE | OTHER | Z63118 | 01 | AZ | GROUP MEDICARE - CLINIC | OTHER | AZ0142 | 01 | EYEMED | OTHER | 15220 | 01 | AVESIS | OTHER | AZ0142 | 01 | EYECARE DIRECT | OTHER | AZ01170 | 01 | AZ | MEDICARE SUBMITTER ID - CLINIC | OTHER | DM2NNP | 01 | ARIZONA FOUNDATION | OTHER | 3Z0277 | 01 | AZ | HEALTH NET | OTHER | NNP12599 | 01 | AZ | UNIVERSAL HEALTH CARE | OTHER |