Individual provider Active NPI

Mary Jane May-Dacus, O.D.

  • Optometrist
  • Cordova, TN
National Provider Identifier
1407994742
Registry record updated Apr 29, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1182 Issued in TN
Practice address
7865 Trinity Rd
Suite 104
Cordova, TN 38018-2273
Phone
(901) 753-7100
Fax
(901) 753-3688
NPI assigned
Feb 1, 2007
Last updated
Apr 29, 2009By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1182 TN Primary

Addresses

Primary practice location

7865 Trinity Rd
Suite 104
Cordova, TN 38018-2273

Mailing address

7865 Trinity Rd
Suite 104
Cordova, TN 38018-2273
Phone (901) 753-7100

Other identifiers 2

IdentifierTypeStateIssuer
P00460728OtherTNMEDICARE RAILROAD CARRIER
3079941OtherTNBLUE CROSS/BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080929000751 TN Practitioner - Optometry 8224105424 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Southern College of Optometry, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eye Care Associates of Co LLCGroup PAC ID 9537597828, 63 clinicians

Practice addresses (Care Compare)

7865 Trinity Rd
Suite 104
Cordova, TN 38018-2274
Phone (901) 753-7100

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1182TNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Eye Care Associates of Co LLC Optometrist CurrentSince Dec 2, 2024 Accepting new patients
Eye Care Associates of Co LLC Optometrist CurrentSince Dec 2, 2024 Accepting new patients

Locations

7865 Trinity Rd
Ste 104
Cordova, TN 38018
Phone (901) 753-7100

4260 Fort Henry Dr
Ste 16
Kingsport, TN 37663
Phone (423) 246-6317

Interoperability endpoints

  • Direct secure messaging: mary.may-dacus@direct.revolutionehr.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240963200000",
    "number": "1407994742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7865 TRINITY RD",
            "address_2": "SUITE 104",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380182273",
            "telephone_number": "901-753-7100",
            "fax_number": "901-753-3688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7865 TRINITY RD",
            "address_2": "SUITE 104",
            "city": "CORDOVA",
            "state": "TN",
            "postal_code": "380182273",
            "telephone_number": "901-753-7100",
            "fax_number": "901-753-3688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAY-DACUS",
        "first_name": "MARY",
        "middle_name": "JANE",
        "name_prefix": "Mrs.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2009-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "1182",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD CARRIER",
            "identifier": "P00460728",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "3079941",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cordova, TN

Sources for this page

Verify at the official NPI Registry.