Provider Demographics
NPI:1952666406
Name:GARCIA TARBETT, CHANTEL NICOLE (OD)
Entity Type:Individual
Prefix:
First Name:CHANTEL
Middle Name:NICOLE
Last Name:GARCIA TARBETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHANTEL
Other - Middle Name:NICOLE
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4350 MAIN ST STE 107
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-7439
Mailing Address - Country:US
Mailing Address - Phone:704-322-3600
Mailing Address - Fax:
Practice Address - Street 1:4350 MAIN ST STE 107
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-7439
Practice Address - Country:US
Practice Address - Phone:305-282-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002650152W00000X
NC2409152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2409OtherNC LICENSE
PAOEG002650OtherLICENSE