Basic Information
| Provider Information | |||||||||
| NPI: | 1689871667 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHN R MARKHAM PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PRESCOTT VISION AND EYE SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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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: | 07/02/2007 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MARKHAM | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | ROBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9287783950 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | OD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 142 | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 207W00000X | AZ | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology | 152W00000X | 1885 | AZ | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 3421045 | 01 | AZ | CIGNA | OTHER | 7442967 | 01 | AZ | AETNA | OTHER | DM2NNP | 01 | ARIZONA FOUNDATION | OTHER | NNP12599 | 01 | AZ | UNIVERSAL HEALTH CARE | OTHER | 033176-001 | 01 | AZ | MERCYCARE | OTHER | 866291-9714 | 01 | HUMANA | OTHER | 033176 | 01 | AZ | AHCCCS | OTHER | 190721 | 01 | AHCCCS | OTHER | 3Z0277 | 01 | AZ | HEALTH NET | OTHER | AZ0142 | 01 | EYECARE DIRECT | OTHER | 1263119 | 01 | AZ | MERCYCARE | OTHER | 190721 | 05 | AZ | MEDICAID | 5858351 | 01 | AETNA | OTHER | 033176 | 05 | AZ | MEDICAID | 153165 | 01 | AZ | RAN-AMN | OTHER | 63119 | 01 | MEDICARE - UNSPECIFIED | OTHER | 15220 | 01 | AVESIS | OTHER | A00148 | 01 | AZ | EYEMED | OTHER | AZ01170 | 01 | MEDICARE SUBMITTER ID - CLINIC | OTHER | AZ0142 | 01 | EYEMED | OTHER | 2Z6546 | 01 | AZ | HEALTH NET | OTHER | 572818 | 01 | AZ | RAN-AMN | OTHER |