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General NPI Number Information
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NPI Number | 1891947610
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Entity Type | Organization
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Legal Business Name | CORDOVA VISION CENTER
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 7865 TRINITY RD SUITE 104
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City | CORDOVA
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State | TN
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Zip | 38018-2273
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Country | US
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Telephone | 901-753-7100
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Fax | 901-753-3688
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Provider Business Mailing Address
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Address Line | 7865 TRINITY RD SUITE 104
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City | CORDOVA
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State | TN
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Zip | 38018-2273
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Country | US
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Telephone | 901-753-7100
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Fax | 901-753-3688
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MARY JANE MAY-DACUS
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Credential | O. D.
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Telephone | 901-753-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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