| Organization Name: | KOKOPELLI EYE CARE OPTICAL DEPT |
| NPI Number: | 1043477847 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BARBIE ELIAS (ADMINISTRATOR) |
| Mailing Address: | 2820 N Glassford Hill Rd Suite 101 Prescott Valley |
| State: | AZ US |
| Postal Code: | 863141242 |
| Phone Number: | 9287755606 |
| Fax Number: | 9287724999 |
| NPI Enumeration Date: | 05/20/2008 |
| NPI Last Update Date: | 05/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FX1800X |
| License Number: | AZ26357 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Optician |
| Taxonomy Definition: | |