Healthcare Provider Details

I. General information

NPI: 1902659055
Provider Name (Legal Business Name): ERICA LEE THARP OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 NAAB RD STE 200
INDIANAPOLIS IN
46260-1933
US

IV. Provider business mailing address

8220 NAAB RD STE 200
INDIANAPOLIS IN
46260-1933
US

V. Phone/Fax

Practice location:
  • Phone: 317-871-5900
  • Fax: 317-872-6439
Mailing address:
  • Phone: 317-871-5900
  • Fax: 317-872-6439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004479A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: