| The Laser & Surgery Center | |
|
500 Port Dr, Clarkston, WA 99403-1835 | |
| (509) 758-8811 | |
| (509) 751-1188 |
| Full Name | The Laser & Surgery Center |
|---|---|
| Type | Facility |
| Speciality | Ophthalmology |
| Location | 500 Port Dr, Clarkston, Washington |
| Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639160450 | NPI | - | NPPES |
| 0123143 | Other | WA | LABOR & INDUSTRY |
| 7088859 | Medicaid | WA | |
| 8927759 | Other | WA | CRIME VICTIMS COMPENSATION ACT |
| BYHB9 | Other | ID | BLUE CROSS OF IDAHO |
| 000010006385 | Other | ID | REGENCE BLUE SHIELD OF IDAHO |
| 805350600 | Medicaid | ID | |
| 85977 | Other | ID | BLUE CROSS OF IDAHO |
| QMXPR0064816 | Other | WA | MOLINA HEALTHCARE |
| 000010006387 | Other | FEDERAL BLUE CROSS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 152W00000X | Optometrist | (* (Not Available)) | Secondary |
| 207W00000X | Ophthalmology | (* (Not Available)) | Primary |
| Provider Name | Chad R Bouterse |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1699896167 PECOS PAC ID: 0648321224 Enrollment ID: I20100225000087 |
| Provider Name | Mark T Eggleston |
|---|---|
| Provider Type | Practitioner - Ophthalmology |
| Provider Identifiers | NPI Number: 1306836705 PECOS PAC ID: 7416958293 Enrollment ID: I20100423000930 |
| Provider Name | Julia Lienesch |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1043623309 PECOS PAC ID: 0840418463 Enrollment ID: I20140822002608 |
| Mailing Address | Practice Location Address |
|---|---|
| The Laser & Surgery Center 500 Port Dr, Clarkston, WA 99403-1835 Ph: (509) 758-8811 | The Laser & Surgery Center 500 Port Dr, Clarkston, WA 99403-1835 Ph: (509) 758-8811 |