Individual
PHILIP DUANE GOICOECHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
115 WEST 3RD, STE 210, HAMILTON, MT 59840-1150
(406) 541-3937
(406) 541-1810
Mailing address
PO BOX 4907, 700 WEST KENT, MISSOULA, MT 59806-4907
(406) 541-3937
(406) 541-1810
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
378
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0480964
—
MT
01
—
807232300
MEDICAID
ID
Enumeration date
09/13/2005
Last updated
04/14/2010
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