Provider Demographics
NPI:1790823201
Name:CONWAY, MARY K (O D)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:CONWAY
Suffix:
Gender:F
Credentials:O D
Other - Prefix:
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Mailing Address - Street 1:3609 AZTEC LN
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37931-3687
Mailing Address - Country:US
Mailing Address - Phone:865-690-4019
Mailing Address - Fax:865-691-2253
Practice Address - Street 1:7600 H KINGSTON PIKE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919-5604
Practice Address - Country:US
Practice Address - Phone:865-691-1118
Practice Address - Fax:865-691-2253
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNTN 1239152WC0802X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Not Answered152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0175608OtherBCBS OF TENNESSEE
TN54-19543OtherAETNA
TN54-19543OtherAETNA
TN3597660Medicare ID - Type Unspecified