Provider Demographics
NPI:1952890097
Name:MCBRIDE, JENNA LACE (OD)
Entity Type:Individual
Prefix:DR
First Name:JENNA
Middle Name:LACE
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:LACE
Other - Last Name:BUCKLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10225 SW HALL BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-8855
Mailing Address - Country:US
Mailing Address - Phone:503-244-1004
Mailing Address - Fax:
Practice Address - Street 1:10225 SW HALL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-8855
Practice Address - Country:US
Practice Address - Phone:032-441-0045
Practice Address - Fax:503-244-1006
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33999152W00000X
OR4660152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist