Healthcare Provider Details

I. General information

NPI: 1750212122
Provider Name (Legal Business Name): PURE IMAGE LASER AND SPA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 S EMERSON AVE STE 120
INDIANAPOLIS IN
46237-8744
US

IV. Provider business mailing address

8350 S EMERSON AVE STE 120
INDIANAPOLIS IN
46237-8744
US

V. Phone/Fax

Practice location:
  • Phone: 317-820-5288
  • Fax:
Mailing address:
  • Phone: 317-820-5288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MECHELLE BARRAS
Title or Position: CO-OWNER
Credential: RN
Phone: 317-730-6300