Provider Demographics
NPI:1780708552
Name:EYE CARE SPECIALISTS PS
Entity type:Organization
Organization Name:EYE CARE SPECIALISTS PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:STE 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:2007-03-19
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAQMXPR0064819OtherMOLINA HEALTHCARE
ID805350600Medicaid
ID85977OtherBLUE CROSS OF IDAHO
IDBYHB9OtherBLUE CROSS OF IDAHO
CN6339OtherRAILROAD MEDICARE
WA7088859Medicaid
WA8927759OtherCRIME VICTIMS COMPENSATION ACT
000010006387OtherFEDERAL BLUE CROSS
ID000010006385OtherREGENCE BLUE SHIELD OF IDAHO
ID1375873OtherIDAHO MEDICARE
WA0123143OtherLABOR & INDUSTRY
WA7088859Medicaid