Provider Demographics
NPI:1275051344
Name:JASON R EGBERT OD PC
Entity Type:Organization
Organization Name:JASON R EGBERT OD PC
Other - Org Name:FIRST SIGHT FAMILY VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBERT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-687-4901
Mailing Address - Street 1:1710 SW 9TH AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-3267
Mailing Address - Country:US
Mailing Address - Phone:360-687-4901
Mailing Address - Fax:
Practice Address - Street 1:1710 SW 9TH AVE STE 112
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604
Practice Address - Country:US
Practice Address - Phone:360-687-4901
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60673019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2063146Medicaid