Provider Demographics
NPI:1902873862
Name:MC BRIDE, DEBORAH ANN (OD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:ANN
Last Name:MC BRIDE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:770 SCOTT BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-6927
Mailing Address - Country:US
Mailing Address - Phone:408-296-0511
Mailing Address - Fax:408-296-1647
Practice Address - Street 1:377 SANTANA ROW STE 1115
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2058
Practice Address - Country:US
Practice Address - Phone:408-502-5020
Practice Address - Fax:408-389-8261
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6506152WC0802X, 152WP0200X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAYYY49956YMedicare PIN
CAT10343Medicare UPIN