Healthcare Provider Details

I. General information

NPI: 1114569795
Provider Name (Legal Business Name): VISION THERAPY INSTITUTE OF SC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2019
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3618 SUNSET BLVD STE A
WEST COLUMBIA SC
29169-3046
US

IV. Provider business mailing address

3618 SUNSET BLVD STE A
WEST COLUMBIA SC
29169-3046
US

V. Phone/Fax

Practice location:
  • Phone: 803-732-4099
  • Fax: 803-227-8992
Mailing address:
  • Phone: 803-732-4099
  • Fax: 803-227-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: KATE D TARVER
Title or Position: OWNER
Credential: O. D. , FCOVD
Phone: 803-413-9618