Provider Demographics
NPI:1114940301
Name:MCBRIDE, CHARLES IRA JR (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:IRA
Last Name:MCBRIDE
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1421 OAKDALE RD
Mailing Address - Street 2:#2
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355
Mailing Address - Country:US
Mailing Address - Phone:209-579-8800
Mailing Address - Fax:209-579-1407
Practice Address - Street 1:1421 OAKDALE RD
Practice Address - Street 2:#2
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355
Practice Address - Country:US
Practice Address - Phone:209-579-8800
Practice Address - Fax:209-579-1407
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-06-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG33080207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4276218Medicaid
CA4276218Medicaid
A45412Medicare UPIN