Provider Demographics
NPI:1821088147
Name:EGGLESTON, RICHARD J (MD)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:J
Last Name:EGGLESTON
Suffix:
Gender:M
Credentials:MD
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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 1:500 PORT DR
Practice Address - Street 2:
Practice Address - City:CLARKSTON
Practice Address - State:WA
Practice Address - Zip Code:99403-1835
Practice Address - Country:US
Practice Address - Phone:509-758-8811
Practice Address - Fax:509-751-1188
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00014109207W00000X
IDM3387207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID000010145028OtherREGENCE BLUE SHIELD OF IDAHO
IDBYHC7OtherBLUE CROSS OF IDAHO
ID000010002377OtherREGENCE BLUE SHIELD OF IDAHO
20031OtherMEDICAL EYE SERVICE
WAMSIWAE400OtherMOLINA HEALTHCARE
ID33878OtherBLUE CROSS OF IDAHO
00010002377OtherFEDERAL BLUE CROSS
WA8927760OtherCRIME VICTIMS COMPENSATION ACT
WA123142OtherLABOR & INDUSTRY
WA12943OtherGROUP HEALTH COOPERATIVE
ID15192OtherLABOR & INDUSTRY
ID003681500Medicaid
WA1051481Medicaid
ID000010002377OtherREGENCE BLUE SHIELD OF IDAHO
20031OtherMEDICAL EYE SERVICE
WA123142OtherLABOR & INDUSTRY
WA1051481Medicaid