MEDICARE: DR. NANCY M MCBRIDE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	TUV56007351	NY
2	152W00000X	Optometrist	4901004881	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	11872180	OTHER	NY	CAQH PROVIDER ID

General Provider Information

NPI Number	:	1649426735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY M MCBRIDE OD

Provider Business Mailing Address
First Line	:	14607 VENTURA BLVD
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3617
Country	:	US
Telephone Number	:	818-789-3311
Fax Number	:	818-789-1047

Provider Business Practice Location Address
First Line	:	6602 TELEGRAPH RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3012
Country	:	US
Telephone Number	:	248-419-3500
Fax Number	:	248-419-3503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	10/18/2016

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