Organization
EYE CARE SPECIALISTS PS
Active
Other names
The Laser and Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK T EGGLESTON MD (PRESIDENT)
(509) 758-8811
Entity
Organization
Contact information
Practice address
500 PORT DR, CLARKSTON, WA 99403-1835
(509) 758-8811
(509) 751-1188
Mailing address
500 PORT DR, CLARKSTON, WA 99403-1835
(509) 758-8811
(509) 751-1188
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
MD00014109
—
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
601269693
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010000776
REGENCE BLUE SHIELD OF IDAHO
ID
01
—
000010000776
FEDERAL BLUE CROSS
—
01
—
0159901
LABOR & INDUSTRY
WA
05
—
7088982
—
WA
05
—
805245400
—
ID
01
—
8929432
CRIME VICTIMS COMPENSATION ACT
WA
01
—
OA263
BLUE CROSS OF IDAHO
ID
Enumeration date
08/15/2006
Last updated
09/20/2011
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