Provider Demographics
NPI:1396788725
Name:SUBONG, ERIC NEIL (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:NEIL
Last Name:SUBONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WESTERLY RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-656-5839
Mailing Address - Fax:360-306-8921
Practice Address - Street 1:200 WESTERLY RD
Practice Address - Street 2:SUITE 101
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226
Practice Address - Country:US
Practice Address - Phone:360-656-5839
Practice Address - Fax:360-306-8921
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD0000041069207W00000X
WAMD00049354207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
4134344OtherBCBS TN
000000211497OtherUNISON
MS07552818Medicaid
AR163826001Medicaid
84231OtherBCBS AR
7360889OtherAETNA
TN3815478Medicaid
4900217OtherCIGNA
40561OtherTLC
3815478Medicare PIN