Provider Demographics
NPI:1114569795
Name:VISION THERAPY INSTITUTE OF SC
Entity Type:Organization
Organization Name:VISION THERAPY INSTITUTE OF SC
Other - Org Name:VISION THERAPY INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TARVER
Authorized Official - Suffix:
Authorized Official - Credentials:O D , FCOVD
Authorized Official - Phone:803-413-9618
Mailing Address - Street 1:3618 SUNSET BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3046
Mailing Address - Country:US
Mailing Address - Phone:803-732-4099
Mailing Address - Fax:803-227-8992
Practice Address - Street 1:3618 SUNSET BLVD STE A
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3046
Practice Address - Country:US
Practice Address - Phone:803-732-4099
Practice Address - Fax:803-227-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-15
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCDA9126Medicaid