Provider Demographics
NPI:1689871667
Name:JOHN R MARKHAM PC
Entity Type:Organization
Organization Name:JOHN R MARKHAM PC
Other - Org Name:PRESCOTT VISION AND EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:MARKHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-778-3950
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-02
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ142152W00000X
AZ1885152W00000X
AZ207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3421045OtherCIGNA
AZ7442967OtherAETNA
DM2NNPOtherARIZONA FOUNDATION
AZNNP12599OtherUNIVERSAL HEALTH CARE
AZ033176-001OtherMERCYCARE
866291-9714OtherHUMANA
AZ033176OtherAHCCCS
190721OtherAHCCCS
AZ3Z0277OtherHEALTH NET
AZ0142OtherEYECARE DIRECT
AZ1263119OtherMERCYCARE
AZ190721Medicaid
5858351OtherAETNA
AZ033176Medicaid
AZ153165OtherRAN-AMN
63119OtherMEDICARE - UNSPECIFIED
15220OtherAVESIS
AZA00148OtherEYEMED
AZ01170OtherMEDICARE SUBMITTER ID - CLINIC
AZ0142OtherEYEMED
AZ2Z6546OtherHEALTH NET
AZ572818OtherRAN-AMN
AZ0384690001Medicare NSC
AZ033176-001OtherMERCYCARE
AZA00148OtherEYEMED
AZ033176Medicaid