Provider Demographics
NPI:1053302331
Name:THARP, LINDA (OD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:THARP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LINDA
Other - Middle Name:L
Other - Last Name:THARP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1750 MADISON AVE
Mailing Address - Street 2:MEMPHIS
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6492
Mailing Address - Country:US
Mailing Address - Phone:901-722-8598
Mailing Address - Fax:901-725-1486
Practice Address - Street 1:1750 MADISON AVE
Practice Address - Street 2:MEMPHIS
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6492
Practice Address - Country:US
Practice Address - Phone:901-722-8598
Practice Address - Fax:901-725-1486
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-04
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNT1393152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7321Medicaid
TN905254Medicaid
TN0201700Medicaid
TN4888Medicaid
TN905254Medicaid