Tristate Optical, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

TRISTATE OPTICAL, INC.

Doing business as

Cunningham Optical One

Practice address

6424 W Jefferson Blvd
Fort Wayne, IN 46804-6204

Phone

(260) 436-2020

Fax

(260) 436-7628

NPI assigned

Sep 26, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Jerry L Bradley

Title

Vice President

Phone

(260) 436-2020

Specialties & licenses 1

Addresses

Other names 1

• Cunningham Optical One Doing business as

Medicare fee-for-service enrollment

Enrolled in IN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Tristate Optical, Inc.

  dba Cunningham Optical One

  • Eyewear Supplier
  • Warsaw, IN
  • NPI 1073509923

  7113045253

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Cunningham Optical One2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Tristate Optical, Inc.

  dba Cunningham Optical One

  • Eyewear Supplier
  • Warsaw, IN
  • NPI 1073509923
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013903962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6424 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046204",
            "telephone_number": "260-436-2020",
            "fax_number": "260-436-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6424 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046204",
            "telephone_number": "260-436-2020",
            "fax_number": "260-436-7628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTATE OPTICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BRADLEY",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "260-436-2020",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cunningham Optical One",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sophia Trimbur-Brasseur
• Trinity Health Pharmacy Services, LLC
• Trinity Health Pharmacy Services, LLC
• Trinity Home Health Care, Inc.
• Trinity Wellness Enterprises, Inc.
• Rupal Trivedi, RD
• John Edward Trok, DDS
• Bradley Trotter, DO
• Megan L. Trotter, NP
• Shane Trotter, PA

• Eyewear Supplier in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Eyewear Supplier in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.