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EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC NPI 1669133492


NPI Information

NPI: 1669133492
Provider Name: EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC
Classification: Ophthalmology - 207WX0200X
Entity Type: Organization

Specialization: Ophthalmic Plastic and Reconstructive Surgery

Address:
929 SW SIMPSON AVE STE 250
BEND, OR
ZIP 97702
Phone: (541) 585-0505
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EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC is an ophthalmic plastic and reconstructive surgery ophthalmology in Bend, OR. The provider is a physician who specializes in oculofacial plastic and reconstructive surgery. This subspecialty combines orbital and periocular surgery with facial plastic surgery, and includes aesthetic and reconstructive surgery of the face, orbit, eyelid, and lacrimal system. Practitioners evaluate, diagnose and treat conditions involving the eyelids, brows, midface, orbits, lacrimal systems and surrounding and supporting structures of the face and neck. EVERGREEN OCULOFACIAL PLASTIC SURGERY LLC NPI is 1669133492. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

929 SW SIMPSON AVE STE 250
BEND, OR
ZIP 97702-599
Phone: (541) 585-0505

The provider's authorized official is Tara Marie Goecks .
The authorized official title is Owner and has the following contact phone number (303) 228-3220.

The enumeration date for this NPI number is 1/4/2022 and was last updated on 3/20/2024.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1207WX0200XOphthalmologyOphthalmic Plastic and Reconstructive SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
11598051732OTHERCOLORADOANTHEM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

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