Provider Demographics
NPI:1649426735
Name:MCBRIDE, NANCY M (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:M
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:14607 VENTURA BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3617
Mailing Address - Country:US
Mailing Address - Phone:818-789-3311
Mailing Address - Fax:818-789-1047
Practice Address - Street 1:6602 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3012
Practice Address - Country:US
Practice Address - Phone:248-419-3500
Practice Address - Fax:248-419-3503
Is Sole Proprietor?:No
Enumeration Date:2008-08-08
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV56007351152WC0802X
MI4901004881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649426735Medicaid
NY11872180OtherCAQH PROVIDER ID