Organization
EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA MARIE GOECKS MD (OWNER)
(303) 228-3220
Entity
Organization
Contact information
Practice address
929 SW SIMPSON AVE STE 250, BEND, OR 97702-3599
(541) 585-0505
Mailing address
PO BOX 6387, BEND, OR 97708-6387
Taxonomy
Speciality
Code
Description
License number
State
207WX0200X
Ophthalmic Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598051732
ANTHEM
CO
Enumeration date
01/04/2022
Last updated
03/20/2024
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