MEDICARE: MR. RICHARD J EGGLESTON MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD00014109	WA
2	207W00000X	Ophthalmology Physician	M3387	ID

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000010145028	OTHER	ID	REGENCE BLUE SHIELD OF IDAHO
2	BYHC7	OTHER	ID	BLUE CROSS OF IDAHO
3	000010002377	OTHER	ID	REGENCE BLUE SHIELD OF IDAHO
4	20031	OTHER		MEDICAL EYE SERVICE
5	MSIWAE400	OTHER	WA	MOLINA HEALTHCARE
6	33878	OTHER	ID	BLUE CROSS OF IDAHO
7	00010002377	OTHER		FEDERAL BLUE CROSS
8	8927760	OTHER	WA	CRIME VICTIMS COMPENSATION ACT
9	123142	OTHER	WA	LABOR & INDUSTRY
10	12943	OTHER	WA	GROUP HEALTH COOPERATIVE
11	15192	OTHER	ID	LABOR & INDUSTRY
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1821088147
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RICHARD J EGGLESTON MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	04/30/2008