Provider Demographics
NPI:1700856267
Name:MCBRIDE, JAMES SHAWN (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:SHAWN
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 1:105 W BLACKWELL ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3555
Mailing Address - Country:US
Mailing Address - Phone:931-455-0654
Mailing Address - Fax:931-455-0669
Practice Address - Street 1:105 W BLACKWELL ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3555
Practice Address - Country:US
Practice Address - Phone:931-455-0654
Practice Address - Fax:931-455-0669
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT1435152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3598559Medicaid
TN3598559Medicare ID - Type Unspecified
TN3598559Medicaid