1437354834 NPI number — MCBRIDE & MCBRIDE OPTOMETRISTS, P.C.

Table of content: (NPI 1437354834)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437354834 NPI number — MCBRIDE & MCBRIDE OPTOMETRISTS, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCBRIDE & MCBRIDE OPTOMETRISTS, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
YELLOWSTONE EYE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437354834
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2120 GRAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59102-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-656-7605
Provider Business Mailing Address Fax Number:
406-656-6430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 GRAND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59102-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-656-7605
Provider Business Practice Location Address Fax Number:
406-656-6430
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEBSOCK
Authorized Official First Name:
SHAWN
Authorized Official Middle Name:
Authorized Official Title or Position:
OPTOMETRIST/OWNER
Authorized Official Telephone Number:
406-656-7605

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332H00000X , with the licence number: MT 505 AND MT 436 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1184363764 . This is a "DR. DIXON MAGGARD NPI" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1205157161 . This is a "DR. JOSEPH STEINER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 1306462098 . This is a "DR. ANGIE BISKUPIAK NPI" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0480571 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0480272 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1124427257 . This is a "DR. SHAWN LEBSOCK NPI" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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