Provider Demographics
NPI:1407994742
Name:MAY-DACUS, MARY JANE (OD)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:MAY-DACUS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7865 TRINITY RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2273
Mailing Address - Country:US
Mailing Address - Phone:901-753-7100
Mailing Address - Fax:901-753-3688
Practice Address - Street 1:7865 TRINITY RD
Practice Address - Street 2:SUITE 104
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38018-2273
Practice Address - Country:US
Practice Address - Phone:901-753-7100
Practice Address - Fax:901-753-3688
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2009-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1182152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00460728OtherMEDICARE RAILROAD CARRIER
TN3079941OtherBLUE CROSS/BLUE SHIELD
TN0785630001Medicare NSC
TN3079941OtherBLUE CROSS/BLUE SHIELD
TNT61329Medicare UPIN