Provider Demographics
NPI:1902985567
Name:MCBRIDE, GIFFORD MARK (OD)
Entity type:Individual
Prefix:DR
First Name:GIFFORD
Middle Name:MARK
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:G
Other - Middle Name:MARK
Other - Last Name:MCBRIDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:9356 S WESTERN AVE
Mailing Address - Street 2:STE B
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-2741
Mailing Address - Country:US
Mailing Address - Phone:405-691-9222
Mailing Address - Fax:405-378-6595
Practice Address - Street 1:9356 S WESTERN AVE
Practice Address - Street 2:STE B
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-2741
Practice Address - Country:US
Practice Address - Phone:405-691-9222
Practice Address - Fax:405-378-6595
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T40556Medicare UPIN