=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437354834
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCBRIDE & MCBRIDE OPTOMETRISTS, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2007
-----------------------------------------------------
Last Update Date | 03/19/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 GRAND AVE
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-2603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-656-7605
-----------------------------------------------------
Fax | 406-656-6430
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2120 GRAND AVE
-----------------------------------------------------
City | BILLINGS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59102-2603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-656-7605
-----------------------------------------------------
Fax | 406-656-6430
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTOMETRIST/OWNER
-----------------------------------------------------
Name | SHAWN LEBSOCK
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 406-656-7605
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number | MT 505 AND MT 436
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------