Provider Demographics
NPI:1275220378
Name:THARP, STEPHANIE JO (LDO)
Entity Type:Individual
Prefix:MISS
First Name:STEPHANIE
Middle Name:JO
Last Name:THARP
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2850 MAYSVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-8967
Mailing Address - Country:US
Mailing Address - Phone:740-452-5047
Mailing Address - Fax:740-452-5275
Practice Address - Street 1:2850 MAYSVILLE PIKE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-8800
Practice Address - Country:US
Practice Address - Phone:740-452-5047
Practice Address - Fax:740-452-5275
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-19
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC010385156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician