Provider Demographics
NPI:1225094550
Name:MARKHAM, JOHN R (O D)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:MARKHAM
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3192 WILLOW CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-6610
Mailing Address - Country:US
Mailing Address - Phone:928-778-3950
Mailing Address - Fax:928-778-3999
Practice Address - Street 1:1680 WILLOW CREEK RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1108
Practice Address - Country:US
Practice Address - Phone:928-778-3950
Practice Address - Fax:928-778-3999
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ142152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ033176Medicaid
153165OtherRAN & AMN
5858351OtherAETNA
AZ033176OtherAHCCCS
866291-9714OtherHUMANA
AZ1263119OtherMERCYCARE
AZZ63118OtherGROUP MEDICARE - CLINIC
AZ0142OtherEYEMED
15220OtherAVESIS
AZ0142OtherEYECARE DIRECT
AZAZ01170OtherMEDICARE SUBMITTER ID - CLINIC
DM2NNPOtherARIZONA FOUNDATION
AZ3Z0277OtherHEALTH NET
AZNNP12599OtherUNIVERSAL HEALTH CARE
15220OtherAVESIS
AZAZ01170OtherMEDICARE SUBMITTER ID - CLINIC
AZT 41904Medicare UPIN
AZT 41904Medicare UPIN