Healthcare Provider Details

I. General information

NPI: 1922161538
Provider Name (Legal Business Name): KEVIN WALTER MCBRIDE O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 GRAND AVE SUITE #1
BILLINGS MT
59102-2603
US

IV. Provider business mailing address

2120 GRAND AVE SUITE #1
BILLINGS MT
59102-2603
US

V. Phone/Fax

Practice location:
  • Phone: 406-656-7605
  • Fax: 406-656-6430
Mailing address:
  • Phone: 406-656-7605
  • Fax: 406-656-6430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number505
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: