Healthcare Provider Details

I. General information

NPI: 1912310897
Provider Name (Legal Business Name): KATE D TARVER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATE L DAVIS OD

II. Dates (important events)

Enumeration Date: 06/09/2014
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: 803-413-9618
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number1816
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1816
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: