Provider Demographics
NPI:1720141583
Name:MCBRIDE, DOUGLAS J (OD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
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 1:2120 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2603
Mailing Address - Country:US
Mailing Address - Phone:406-656-7605
Mailing Address - Fax:406-656-6430
Practice Address - Street 1:2120 GRAND AVE
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-2603
Practice Address - Country:US
Practice Address - Phone:406-656-7605
Practice Address - Fax:406-656-6430
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT436152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0480272Medicaid
MT0000083625Medicare ID - Type Unspecified
MTT89259Medicare UPIN