MEDICARE: DR. HARRY C EGGLESTON M.D.

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	R4544	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45050	OTHER	MO	GHP
2	A10830	OTHER	MO	GREATWEST HEALTHCARE
3	101139	OTHER	MO	HEALTHLINK
4	0800077	OTHER	MO	UNITED HEALTHCARE
5	17203	OTHER	MO	BCBS
6	4039678	OTHER	MO	AETNA

General Provider Information

NPI Number	:	1912995317
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRY C EGGLESTON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 790051
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63179-0051
Country	:	US
Telephone Number	:	314-872-7744
Fax Number	:	314-810-5296

Provider Business Practice Location Address
First Line	:	633 EMERSON RD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-6739
Country	:	US
Telephone Number	:	314-872-7744
Fax Number	:	314-810-5296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2005
Last Update Date	:	01/18/2008

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Directions to “ DR. HARRY C EGGLESTON M.D.” Practice Location

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