Organization
EYE CARE SPECIALISTS PS
Active
Other names
The Laser and Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK T EGGLESTON MD (PRESIDENT)
(509) 758-8811
Entity
Organization
Contact information
Practice address
825 SE BISHOP BLVD, STE 110, PULLMAN, WA 99163-5517
(509) 334-1661
(509) 334-1788
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
01
—
1375873
IDAHO MEDICARE
ID
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
—
CN6339
RAILROAD MEDICARE
—
01
—
QMXPR0064819
MOLINA HEALTHCARE
WA
Enumeration date
03/19/2007
Last updated
09/20/2011
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