Tristate Optical, Inc.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

TRISTATE OPTICAL, INC.

Doing business as

Cunningham Optical One

Practice address

2932 Frontage Rd
Warsaw, IN 46580-3914

Phone

(574) 269-2223

Fax

(574) 269-3088

NPI assigned

Sep 26, 2005

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

(574) 269-2223

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.

  • Eyewear Supplier
  • Fort Wayne, IN
  • NPI 1013903962

  7113045253

  Same PAC ID

Tax ID family

Tristate Optical Inc2 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.

  • Eyewear Supplier
  • Fort Wayne, IN
  • NPI 1013903962
  NPD tax ID

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": "1073509923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2932 FRONTAGE RD",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803914",
            "telephone_number": "574-269-2223",
            "fax_number": "574-269-3088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2932 FRONTAGE RD",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465803914",
            "telephone_number": "574-269-2223",
            "fax_number": "574-269-3088"
        }
    ],
    "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": "574-269-2223",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cunningham Optical One",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rebekah Elizabeth Todd, O.D.
• Paul Tolson
• Brooke Renee Trabert, PHARMD
• Brianna Tran
• Transmed Associates, Inc.
• Tabitha Trosper, MSW, LCSW
• Amber Dawn Trump, MSPT, CLT-LANA
• Dortha Tucker
• Maggie Tuggle
• Aaron Turner

• Eyewear Supplier in Warsaw, IN
• Providers in Warsaw, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.