Provider Demographics
NPI:1184175416
Name:KOKOPELLI EYE CARE PC
Entity type:Organization
Organization Name:KOKOPELLI EYE CARE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-308-5109
Mailing Address - Street 1:2820 N GLASSFORD HILL RD
Mailing Address - Street 2:STE 101
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-1242
Mailing Address - Country:US
Mailing Address - Phone:928-771-9000
Mailing Address - Fax:
Practice Address - Street 1:15033 W BELL RD STE 150
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3262
Practice Address - Country:US
Practice Address - Phone:844-565-6393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier