Provider Demographics
NPI:1194906156
Name:HARRY C EGGLESTON MD PC II
Entity type:Organization
Organization Name:HARRY C EGGLESTON MD PC II
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:EGGLESTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-872-7744
Mailing Address - Street 1:PO BOX 790051
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0051
Mailing Address - Country:US
Mailing Address - Phone:314-872-7744
Mailing Address - Fax:314-810-5296
Practice Address - Street 1:633 EMERSON RD
Practice Address - Street 2:STE 100
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-6739
Practice Address - Country:US
Practice Address - Phone:314-872-7744
Practice Address - Fax:314-810-5296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4544207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101139OtherHEALTHLINK
MOCS9334OtherRAILROAD MEDICRE
MO17203OtherBCBS
MOA10830OtherGREAT WEST HEALTHCARE
MO069464001OtherCIGNA
MO4039678OtherAETNA
MO45050OtherGHP
MO000011504OtherMEDICARE PIN
MO0800077OtherUNITED HEALTHCARE
MO4039678OtherAETNA