Active NPI
Philip Duane Goicoechea, OD
- Optometrist
- Hamilton, MT
National Provider Identifier
1558356824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 378
- Practice address
- 115 West 3Rd
Ste 210
Hamilton, MT 59840-1150 - Phone
- (406) 541-3937
- Fax
- (406) 541-1810
- NPI assigned
- Sep 13, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 378 | MT | Primary |
Addresses
Primary practice location
115 West 3Rd
Ste 210
Hamilton, MT 59840-1150
Mailing address
PO Box 4907
700 West Kent
Missoula, MT 59806-4907
Phone (406) 541-3937
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0480964 | Medicaid | MT | |
| 807232300 | Other | ID | MEDICAID |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 378 | MT | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1126569600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1271203200000",
"number": "1558356824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4907",
"address_2": "700 WEST KENT",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598064907",
"telephone_number": "406-541-3937",
"fax_number": "406-541-1810"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "115 WEST 3RD",
"address_2": "STE 210",
"city": "HAMILTON",
"state": "MT",
"postal_code": "598401150",
"telephone_number": "406-541-3937",
"fax_number": "406-541-1810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOICOECHEA",
"first_name": "PHILIP",
"middle_name": "DUANE",
"credential": "OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-13",
"last_updated": "2010-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MT",
"license": "378",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0480964",
"state": "MT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAID",
"identifier": "807232300",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hamilton, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.