Active NPI
Eye Care Specialists PS
- Ophthalmology Physician
- Pullman, WA
National Provider Identifier
1780708552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- Legal business name
- EYE CARE SPECIALISTS PS
- Practice address
- 825 SE Bishop Blvd
Ste 110
Pullman, WA 99163-5517 - Phone
- (509) 334-1661
- Fax
- (509) 334-1788
- NPI assigned
- Mar 19, 2007
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Dr. Mark T Eggleston, MD
- Title
- President
- Phone
- (509) 758-8811
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | |||
| Ophthalmology Physician | 207W00000X | Primary |
Addresses
Primary practice location
825 SE Bishop Blvd
Ste 110
Pullman, WA 99163-5517
Mailing address
500 Port Dr
Clarkston, WA 99403-1835
Phone (509) 758-8811
Other identifiers 11
| Identifier | Type | State | Issuer |
|---|---|---|---|
| QMXPR0064819 | Other | WA | MOLINA HEALTHCARE |
| 805350600 | Medicaid | ID | |
| 85977 | Other | ID | BLUE CROSS OF IDAHO |
| BYHB9 | Other | ID | BLUE CROSS OF IDAHO |
| CN6339 | Other | RAILROAD MEDICARE | |
| 7088859 | Medicaid | WA | |
| 8927759 | Other | WA | CRIME VICTIMS COMPENSATION ACT |
| 000010006387 | Other | FEDERAL BLUE CROSS | |
| 000010006385 | Other | ID | REGENCE BLUE SHIELD OF IDAHO |
| 1375873 | Other | ID | IDAHO MEDICARE |
| 0123143 | Other | WA | LABOR & INDUSTRY |
Other names 1
- The Laser and Surgery Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040317000302 | WA | Part B Supplier - Clinic/Group Practice | 3779473723 |
Receives reassigned benefits from 3 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clarkston, WA |
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
500 Port Dr
Clarkston, WA 99403
Phone (509) 758-8811
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174262400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1316476800000",
"number": "1780708552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "500 PORT DR",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994031835",
"telephone_number": "509-758-8811",
"fax_number": "509-751-1188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "825 SE BISHOP BLVD",
"address_2": "STE 110",
"city": "PULLMAN",
"state": "WA",
"postal_code": "991635517",
"telephone_number": "509-334-1661",
"fax_number": "509-334-1788"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "EYE CARE SPECIALISTS PS",
"organizational_subpart": "NO",
"enumeration_date": "2007-03-19",
"last_updated": "2011-09-20",
"status": "A",
"authorized_official_last_name": "EGGLESTON",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "T",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "509-758-8811",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": false
},
{
"code": "207W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Ophthalmology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA HEALTHCARE",
"identifier": "QMXPR0064819",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "805350600",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "85977",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "BYHB9",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CN6339",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7088859",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS COMPENSATION ACT",
"identifier": "8927759",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLUE CROSS",
"identifier": "000010006387",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF IDAHO",
"identifier": "000010006385",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDAHO MEDICARE",
"identifier": "1375873",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRY",
"identifier": "0123143",
"state": "WA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "The Laser and Surgery Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Pullman, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.