Provider Demographics
NPI:1386489870
Name:THORP, MADALYN ROSE (OD)
Entity type:Individual
Prefix:
First Name:MADALYN
Middle Name:ROSE
Last Name:THORP
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 1:1226 TURNBERRY LN
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:IN
Mailing Address - Zip Code:46706-9486
Mailing Address - Country:US
Mailing Address - Phone:419-508-4112
Mailing Address - Fax:
Practice Address - Street 1:712 CAMERON WOODS DR
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-8816
Practice Address - Country:US
Practice Address - Phone:260-665-3240
Practice Address - Fax:260-668-7953
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004520A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist