MARK T EGGLESTON (NPI# 1306836705) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306836705 |
| Entity Type | Individual |
| Full Name | MARK T EGGLESTON |
| Credential | MD |
| Practice Address |
500 Port Drive Clarkston WA 99403-1835 |
| Practice Telephone | 5097588811 |
| Practice Fax Number | 5097511188 |
| Mailing Telephone | 5097588811 |
| Mailing Fax Number | 5097511188 |
| Enumeration Date | 2005-10-26 |
| Last Update Date | 2008-04-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207W00000X | Ophthalmology | M8239 | ID | Allopathic & Osteopathic Physicians |
| Y | 207W00000X | Ophthalmology | MD00039323 | WA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FEDERAL BLUE CROSS | 0000100033114 | 01 | |
| ID | REGENCE BLUE SHIELD OF IDAHO | 000010033114 | 01 |
| WA | LABOR & INDUSTRY | 0152789 | 01 |
| ID | 806011100 | 05 | |
| ID | REGENCE BLUE SHIELD OF IDAHO | 000010145029 | 01 |
| WA | 8293425 | 05 | |
| WA | CRIME VICTIMES COMPENSATION ACT | 8928983 | 01 |
| ID | BLUE CROSS OF IDAHO | BYHD5 | 01 |
| ID | BLUE CROSS OF IDAHO | 42663 | 01 |
| WA | GROUP HEALTH COOPERATIVE | 24509 | 01 |
| WA | MOLINA HEALTHCARE | MXXPR0054708 | 01 |
| Street Address |
500 PORT DRIVE |
| City | CLARKSTON |
| State | WA |
| Zip Code | 99403-1835 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306409669 | Jessica Elaine Krull | Specialist/Technologist | 807 3rd Street, Clarkston, WA 99403 | 2019-04-22 |
| 1477006526 | Idaho County Rideshare | Non-emergency Medical Transport (VAN) | 1470 Elm Street, Clarkston, WA 99403 | 2016-07-25 |
| 1679921340 | Jonathan Preszler | Counselor | 629 6th Street, Educational and Psychological Services, Clarkston, WA 99403 | 2016-06-02 |
| 1104204957 | Optimal Health and Wellness | Clinic/Center | 1267 Belmont Way, Clarkston, WA 99403 | 2015-05-13 |
| 1326456351 | David Nygren | Pharmacist | 506 5th St, Clarkston, WA 99403 | 2014-07-22 |
| 1255672895 | Alpowa Healthcare, Inc. | Hospice Care, Community Based | 1370 Bridge Street, Clarkston, WA 99403 | 2013-03-06 |
| 1265799407 | Elizabeth Bagnulo Dacey | Pathology | 1225 Highland Avenue, Clarkston, WA 99403 | 2012-04-12 |
| 1649586256 | Zeeshan Afzal | Internal Medicine | 1119 Highland Ave Ste 3, Clarkston, WA 99403 | 2010-08-20 |
| 1154657955 | Twin River Vision, Inc. | Optometrist | 306 5th Street, Clarkston, WA 99403 | 2009-10-29 |
| 1649429317 | Elizabeth Marie Allen-racicot | Specialist | 1013 Bridge Street, Clarkston, WA 99403 | 2008-09-17 |
| Find all providers in zip 99403 | ||||
| Taxonomy Code | 207W00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Ophthalmology |
| An ophthalmologist has the knowledge and professional skills needed to provide comprehensive eye and vision care. Ophthalmologists are medically trained to diagnose, monitor and medically or surgically treat all ocular and visual disorders. This includes problems affecting the eye and its component structures, the eyelids, the orbit and the visual pathways. In so doing, an ophthalmologist prescribes vision services, including glasses and contact lenses. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Ophthalmology, 2007. http://www.abop.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Ophthalmology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912385154 | Stefanie Denise Sherman | Ophthalmology | 5825 S Main St Ste 100, Clarkston, MI 48346-2983 | 2015-05-07 |
| 1154358190 | Saul M Rubenstein | Ophthalmology | 6875 Dixie Hwy, Clarkston, MI 48346-2008 | 2006-06-26 |
| 1821088147 | Richard J Eggleston | Ophthalmology | 500 Port Dr, Clarkston, WA 99403-1835 | 2005-10-27 |
| 1538154125 | Arlin H French | Ophthalmology | 5825 S Main St, Suite 100, Clarkston, MI 48346-2983 | 2005-09-20 |
| 1134460272 | Wilkinson Eye Center | Ophthalmology | 6875 Dixie Hwy, Clarkston, MI 48346-5106 | 2013-03-14 |
| 1922249937 | Oakland Eye Care, P.C. | Ophthalmology | 5701 Bow Pointe Dr, Suite 135, Clarkston, MI 48346-3198 | 2009-03-20 |
| 1760632004 | W Richard Herbert Md Ps | Ophthalmology | 617 Diagonal St, Clarkston, WA 99403-2041 | 2008-09-23 |
| 1699896167 | Chad Ryan Bouterse | Ophthalmology | 500 Port Dr, Clarkston, WA 99403-1835 | 2007-04-03 |
| 1245332980 | Oakland Eye Care, P.C. | Ophthalmology | 5825 S Main St, Suite 100, Clarkston, MI 48346-2983 | 2006-09-02 |
| 1083724900 | Christopher Naresh Singh | Ophthalmology | 5885 S Main St, Ste 2, Clarkston, MI 48346-2981 | 2006-08-30 |
| Find all providers in CLARKSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.