Tristate Professional Services Inc

Primary specialty

OptometristTaxonomy code 152W00000X

License

046006399 Issued in IL

Legal business name

TRISTATE PROFESSIONAL SERVICES INC

Practice address

2760 N Dirksen Pkwy
Attn: Walmart Vision Ctr
Springfield, IL 62702-1448

Phone

(217) 522-4396

Fax

(217) 522-4861

NPI assigned

Dec 16, 2009

Last updated

Dec 16, 2009By 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

Dr. Robert P Edwards, ODNPI 1396753059

Title

President

Phone

(217) 259-8461

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Robert P Edwards, O.D.

  • Optometrist
  • Springfield, IL
  • NPI 1396753059
  NPD (past) Authorized official

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

{
    "created_epoch": "1260921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260921600000",
    "number": "1194054452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 E JACKSON ST",
            "city": "RIVERTON",
            "state": "IL",
            "postal_code": "625618064",
            "telephone_number": "217-259-8461",
            "fax_number": "217-522-4861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2760 N DIRKSEN PKWY",
            "address_2": "ATTN: WALMART VISION CTR",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627021448",
            "telephone_number": "217-522-4396",
            "fax_number": "217-522-4861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRISTATE PROFESSIONAL SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-16",
        "last_updated": "2009-12-16",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "217-259-8461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046006399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tara Trent, PA-C
• Michael Scott Trieger, PSY.D.
• Allison M Trigg, APN
• Caitlyn Paige Trim
• Shreepada Tripathy
• Mehul Alkesh Trivedi, PH.D.
• James Troiano
• John R. Trost, M.D.
• Carolyn Elyce Trout
• Angela Frances Trowbridge

• Optometrist in Springfield, IL
• Providers in Springfield, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.