MEDICARE: DR. DEBORAH ANN MC BRIDE O.D.

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	6506	CA
2	152WP0200X	Pediatric Optometrist	6506	CA
3	152W00000X	Optometrist	6506	CA

General Provider Information

NPI Number	:	1902873862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORAH ANN MC BRIDE O.D.

Provider Business Mailing Address
First Line	:	770 SCOTT BLVD
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-6927
Country	:	US
Telephone Number	:	408-296-0511
Fax Number	:	408-296-1647

Provider Business Practice Location Address
First Line	:	377 SANTANA ROW STE 1115
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95128-2058
Country	:	US
Telephone Number	:	408-502-5020
Fax Number	:	408-389-8261

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	07/16/2024

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