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1376556514

NPI Code Detail

MEDICARE: EYE CARE SPECIALISTS PS

MEDICARE: EYE CARE SPECIALISTS PS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD00014109
2	261QA1903X	Ambulatory Surgical Clinic/Center	601269693	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010000776	OTHER	ID	REGENCE BLUE SHIELD OF IDAHO
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	000010000776	OTHER		FEDERAL BLUE CROSS
4	OA263	OTHER	ID	BLUE CROSS OF IDAHO
5	8929432	OTHER	WA	CRIME VICTIMS COMPENSATION ACT
6	0159901	OTHER	WA	LABOR & INDUSTRY
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376556514
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE CARE SPECIALISTS PS

Provider Business Mailing Address
First Line	:	500 PORT DR
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-1835
Country	:	US
Telephone Number	:	509-758-8811
Fax Number	:	509-751-1188

Provider Business Practice Location Address
First Line	:	500 PORT DR
Second Line	:
City	:	CLARKSTON
State	:	WA
Zip	:	99403-1835
Country	:	US
Telephone Number	:	509-758-8811
Fax Number	:	509-751-1188

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK T EGGLESTON
Credential	:	MD
Telephone Number	:	509-758-8811

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	09/20/2011

Similar Medicare Providers

1306836705 — MARK T EGGLESTON MD
Practice Location Address:

500 PORT DRIVE
CLARKSTON, WA
99403-1835

Practice Phone: 509-758-8811
Practice Fax: 509-751-1188

1821088147 — MR. RICHARD J EGGLESTON MD
Practice Location Address:

500 PORT DR
CLARKSTON, WA
99403-1835

Practice Phone: 509-758-8811
Practice Fax: 509-751-1188

1639160450 — EYE CARE SPECIALISTS PS
Practice Location Address:

500 PORT DR
CLARKSTON, WA
99403-1835

Practice Phone: 509-758-8811
Practice Fax: 509-751-1188

1972514917 — EYE CARE SPECIALISTS PS
Practice Location Address:

500 PORT DR
CLARKSTON, WA
99403-1835

Practice Phone: 509-758-8811
Practice Fax: 509-751-1188

1649361007 — MARY L MUENCH CRNA
Practice Location Address:

500 PORT DR
CLARKSTON, WA
99403-1835

Practice Phone: 509-758-8811
Practice Fax: 509-751-1188

1699896167 — CHAD RYAN BOUTERSE D.O.
Practice Location Address:

500 PORT DR
CLARKSTON, WA
99403-1835

Practice Phone: 509-758-8811
Practice Fax: 509-751-1188

Directions to “EYE CARE SPECIALISTS PS ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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