Provider Demographics
NPI:1538278676
Name:MCBRIDE, DAVID J (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:J
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 1:8566 SW APPLE WAY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97225-1772
Mailing Address - Country:US
Mailing Address - Phone:503-297-4183
Mailing Address - Fax:503-297-3494
Practice Address - Street 1:8566 SW APPLE WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1772
Practice Address - Country:US
Practice Address - Phone:503-297-4183
Practice Address - Fax:503-297-3494
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1781ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR824219000OtherBLUE CROSS BLUE SHIELD
OR824219000OtherBLUE CROSS BLUE SHIELD
OR45181800001Medicare NSC