Provider Demographics
NPI:1760594709
Name:EYE CARE SPECIALISTS PS
Entity Type:Organization
Organization Name:EYE CARE SPECIALISTS PS
Other - Org Name:THE LASER AND SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-758-8811
Mailing Address - Street 1:500 PORT DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSTON
Mailing Address - State:WA
Mailing Address - Zip Code:99403-1835
Mailing Address - Country:US
Mailing Address - Phone:509-758-8811
Mailing Address - Fax:509-751-1188
Practice Address - Street 1:825 SE BISHOP BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5517
Practice Address - Country:US
Practice Address - Phone:509-334-1661
Practice Address - Fax:509-334-1788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0265530003OtherDMERC
WA8927759OtherCRIME VICTIMS COMPENSATIO
ID8I052OtherBLUE CROSS OF IDAHO
000010006387OtherFEDERAL BLUE CROSS
WA7088859Medicaid
ID85977OtherBLUE CROSS OF IDAHO
ID8I045OtherBLUE CROSS OF IDAHO
WA0265530002OtherDMERC
ID1375873OtherMEDICARE
ID805350600OtherMEDICAID
WA0123143OtherLABOR AND IND
000010006385OtherREGENCE BLUE SHIELD
000010006387OtherREGENCE BLUE SHIELD OPTIC
ID002639500OtherMEDICAID OPTICAL
WABYHB9OtherBLUE CROSS OF IDAHO
000010006387OtherFEDERAL BLUE CROSS