Basic Information
| Provider Information | |||||||||
| NPI: | 1932540119 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHN R MARKHAM PC | ||||||||
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| OtherOrganizationName: | PRESCOTT VISION AND EYE SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1680 WILLOW CREEK RD | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863011108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287783950 | ||||||||
| FaxNumber: | 9287783999 | ||||||||
| Practice Location | |||||||||
| Address1: | 3223 N WINDSONG DR | ||||||||
| Address2: | |||||||||
| City: | PRESCOTT VALLEY | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 863141222 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9287783950 | ||||||||
| FaxNumber: | 9287783999 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | MARKHAM | ||||||||
| AuthorizedOfficialFirstName: | SCOTT | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9287783950 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | AZ | N | 193200000X MULTI-SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist | 207W00000X | AZ | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.