Provider Demographics
NPI:1104556406
Name:COOK, TABITHA MARTINA (LICENSED OPTICIAN)
Entity type:Individual
Prefix:MRS
First Name:TABITHA
Middle Name:MARTINA
Last Name:COOK
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:MRS
Other - First Name:TABITHA
Other - Middle Name:MARTINA
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED OPTICIAN
Mailing Address - Street 1:4875 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-8127
Mailing Address - Country:US
Mailing Address - Phone:803-323-2097
Mailing Address - Fax:803-980-0076
Practice Address - Street 1:4875 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-8127
Practice Address - Country:US
Practice Address - Phone:803-323-2097
Practice Address - Fax:803-980-0076
Is Sole Proprietor?:No
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1213156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician