Active NPI
Richard J Eggleston, MD
- Ophthalmology Physician
- Clarkston, WA
National Provider Identifier
1821088147
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- MD00014109
- Practice address
- 500 Port Dr
Clarkston, WA 99403-1835 - Phone
- (509) 758-8811
- Fax
- (509) 751-1188
- NPI assigned
- Oct 27, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | MD00014109 | WA | Primary |
| Ophthalmology Physician | 207W00000X | M3387 | ID |
Addresses
Primary practice location
500 Port Dr
Clarkston, WA 99403-1835
Mailing address
500 Port Dr
Clarkston, WA 99403-1835
Phone (509) 758-8811
Other identifiers 13
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000010145028 | Other | ID | REGENCE BLUE SHIELD OF IDAHO |
| BYHC7 | Other | ID | BLUE CROSS OF IDAHO |
| 000010002377 | Other | ID | REGENCE BLUE SHIELD OF IDAHO |
| 20031 | Other | MEDICAL EYE SERVICE | |
| MSIWAE400 | Other | WA | MOLINA HEALTHCARE |
| 33878 | Other | ID | BLUE CROSS OF IDAHO |
| 00010002377 | Other | FEDERAL BLUE CROSS | |
| 8927760 | Other | WA | CRIME VICTIMS COMPENSATION ACT |
| 123142 | Other | WA | LABOR & INDUSTRY |
| 12943 | Other | WA | GROUP HEALTH COOPERATIVE |
| 15192 | Other | ID | LABOR & INDUSTRY |
| 003681500 | Medicaid | ID | |
| 1051481 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| M3387 | ID | MD | Ophthalmology Physician |
| MD00014109 | WA | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130371200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1209513600000",
"number": "1821088147",
"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": "500 PORT DR",
"city": "CLARKSTON",
"state": "WA",
"postal_code": "994031835",
"telephone_number": "509-758-8811",
"fax_number": "509-751-1188"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EGGLESTON",
"first_name": "RICHARD",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-27",
"last_updated": "2008-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "WA",
"license": "MD00014109",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "ID",
"license": "M3387",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF IDAHO",
"identifier": "000010145028",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "BYHC7",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BLUE SHIELD OF IDAHO",
"identifier": "000010002377",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL EYE SERVICE",
"identifier": "20031",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA HEALTHCARE",
"identifier": "MSIWAE400",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS OF IDAHO",
"identifier": "33878",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL BLUE CROSS",
"identifier": "00010002377",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS COMPENSATION ACT",
"identifier": "8927760",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRY",
"identifier": "123142",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP HEALTH COOPERATIVE",
"identifier": "12943",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRY",
"identifier": "15192",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "003681500",
"state": "ID"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1051481",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clarkston, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.