Organization
EYE CARE SPECIALISTS PS
Active
Other names
The Laser & 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
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010006385
REGENCE BLUE SHIELD OF IDAHO
ID
01
—
000010006387
FEDERAL BLUE CROSS
—
01
—
0123143
LABOR & INDUSTRY
WA
05
—
7088859
—
WA
05
—
805350600
—
ID
01
—
85977
BLUE CROSS OF IDAHO
ID
01
—
8927759
CRIME VICTIMS COMPENSATION ACT
WA
01
—
BYHB9
BLUE CROSS OF IDAHO
ID
01
—
QMXPR0064816
MOLINA HEALTHCARE
WA
Enumeration date
11/01/2005
Last updated
04/30/2008
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