Provider Demographics
NPI:1912310897
Name:TARVER, KATE D (OD)
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:D
Last Name:TARVER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATE
Other - Middle Name:L
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
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:803-413-9618
Mailing Address - Fax:
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
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1816152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCD18167Medicaid