Provider Demographics
NPI:1053303495
Name:MCBRIDE, CHALRES ALBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHALRES
Middle Name:ALBERT
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12370 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-2847
Mailing Address - Country:US
Mailing Address - Phone:503-644-3614
Mailing Address - Fax:503-646-4069
Practice Address - Street 1:12370 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-2847
Practice Address - Country:US
Practice Address - Phone:503-644-3614
Practice Address - Fax:503-646-4069
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2542T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR00WCPFFCMedicare ID - Type Unspecified
ORU59418Medicare UPIN