Active NPI
Charles Ira McBride Jr., MD
- Ophthalmology Physician
- Modesto, CA
National Provider Identifier
1114940301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- G33080
- Practice address
- 1421 Oakdale Rd
#2
Modesto, CA 95355 - Phone
- (209) 579-8800
- Fax
- (209) 579-1407
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | G33080 | CA | Primary |
Addresses
Primary practice location
1421 Oakdale Rd
#2
Modesto, CA 95355
Mailing address
1421 Oakdale Rd
#2
Modesto, CA 95355
Phone (209) 579-8800
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4276218 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1212364800000",
"number": "1114940301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1421 OAKDALE RD",
"address_2": "#2",
"city": "MODESTO",
"state": "CA",
"postal_code": "95355",
"telephone_number": "209-579-8800",
"fax_number": "209-579-1407"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1421 OAKDALE RD",
"address_2": "#2",
"city": "MODESTO",
"state": "CA",
"postal_code": "95355",
"telephone_number": "209-579-8800",
"fax_number": "209-579-1407"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCBRIDE",
"first_name": "CHARLES",
"middle_name": "IRA",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2008-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "CA",
"license": "G33080",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4276218",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.