Healthcare Provider Details

I. General information

NPI: 1902873862
Provider Name (Legal Business Name): DEBORAH ANN MC BRIDE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

377 SANTANA ROW STE 1115
SAN JOSE CA
95128-2058
US

IV. Provider business mailing address

770 SCOTT BLVD
SANTA CLARA CA
95050-6927
US

V. Phone/Fax

Practice location:
  • Phone: 408-502-5020
  • Fax: 408-389-8261
Mailing address:
  • Phone: 408-296-0511
  • Fax: 408-296-1647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number6506
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number6506
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: