Provider Demographics
NPI:1801843214
Name:THARP, SHARON KAY (OD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:KAY
Last Name:THARP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W 29TH ST
Mailing Address - Street 2:STE 302
Mailing Address - City:S SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-3852
Mailing Address - Country:US
Mailing Address - Phone:402-494-5533
Mailing Address - Fax:402-494-5534
Practice Address - Street 1:1000 W 29TH ST
Practice Address - Street 2:STE 302
Practice Address - City:S SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3852
Practice Address - Country:US
Practice Address - Phone:402-494-5533
Practice Address - Fax:402-494-5534
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47076275100Medicaid
0392900001OtherDMERC
NE47076275100Medicaid
NE087057Medicare PIN