Provider Demographics
NPI:1467551804
Name:BANKS-MCBRIDE, DANA LYNN (DD)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:LYNN
Last Name:BANKS-MCBRIDE
Suffix:
Gender:F
Credentials:DD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 KRIS DR
Mailing Address - Street 2:APT #210
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108
Mailing Address - Country:US
Mailing Address - Phone:412-269-3411
Mailing Address - Fax:
Practice Address - Street 1:289 MT NEBO POINTE DR
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237
Practice Address - Country:US
Practice Address - Phone:412-364-6937
Practice Address - Fax:412-364-5058
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000771152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01889506Medicaid
PA1374262OtherPENNVISION OPTICHOICE
BA004681Medicare ID - Type Unspecified
PA01889506Medicaid