Provider Demographics
NPI:1891947610
Name:CORDOVA VISION CENTER
Entity Type:Organization
Organization Name:CORDOVA VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MAY-DACUS
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:901-753-7100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-13
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00683045OtherMEDICARE RAILROAD
TN0785630001Medicare NSC