Individual provider Active NPI

Mary K Conway, O. D.

  • Pediatric Optometrist
  • Knoxville, TN
National Provider Identifier
1790823201
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric OptometristTaxonomy code 152WP0200X
License
TN 1239 Issued in TN
Practice address
7600 H Kingston Pike
Knoxville, TN 37919-5604
Phone
(865) 691-1118
Fax
(865) 691-2253
NPI assigned
Feb 5, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Corneal and Contact Management Optometrist 152WC0802X TN 1239 TN
Pediatric Optometrist 152WP0200X TN 1239 TN Primary

Addresses

Primary practice location

7600 H Kingston Pike
Knoxville, TN 37919-5604

Mailing address

3609 Aztec LN
Knoxville, TN 37931-3687
Phone (865) 690-4019

Other identifiers 2

IdentifierTypeStateIssuer
0175608OtherTNBCBS OF TENNESSEE
54-19543OtherTNAETNA

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
I20240702003037 TN Practitioner - Optometry 0547704413 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TN 1239TNMDCorneal and Contact Management Optometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Campbell Cunningham Taylor PC CurrentSince Jul 1, 2024 Accepting new patients
Dr. Mary Conway & Associates LLC Current Accepting new patients
Campbell Cunningham Taylor PC CurrentSince Jul 1, 2024 Accepting new patients

Locations

1124 E Weisgarber Rd
Ste 100
Knoxville, TN 37909
Phone 8655840905322

4613 Papermill Dr
Knoxville, TN 37909
Phone (865) 584-8551

Interoperability endpoints

  • Direct secure messaging: mconway@ccth.intellechartdirect.net

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": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1790823201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3609 AZTEC LN",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379313687",
            "telephone_number": "865-690-4019",
            "fax_number": "865-691-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 H KINGSTON PIKE",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379195604",
            "telephone_number": "865-691-1118",
            "fax_number": "865-691-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONWAY",
        "first_name": "MARY",
        "middle_name": "K",
        "name_prefix": "Dr.",
        "credential": "O. D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "TN",
            "license": "TN 1239",
            "primary": false
        },
        {
            "code": "152WP0200X",
            "taxonomy_group": "",
            "desc": "Optometrist, Pediatrics",
            "state": "TN",
            "license": "TN 1239",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TENNESSEE",
            "identifier": "0175608",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "54-19543",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

Verify at the official NPI Registry.