TRISTATE OPTICAL, INC. (NPI# 1013903962) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013903962 |
| Entity Type | Organization |
| Organization Name | TRISTATE OPTICAL, INC. |
| Other Organization Name | CUNNINGHAM OPTICAL ONE |
| Practice Address |
6424 W Jefferson Blvd Fort Wayne IN 46804-6204 |
| Practice Telephone | 2604362020 |
| Practice Fax Number | 2604367628 |
| Mailing Telephone | 2604362020 |
| Mailing Fax Number | 2604367628 |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JERRY L BRADLEY (VICE PRESIDENT) |
| Authorized Official Telephone | 2604362020 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332H00000X | Eyewear Supplier (Equipment, not the service) | Suppliers |
| Other Name | Type Code |
|---|---|
| Cunningham Optical One | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073509923 | Tristate Optical, Inc. | Eyewear Supplier (Equipment, not the service) | 2932 Frontage Rd, Warsaw, IN 46580-3914 | 2005-09-26 |
| Street Address |
6424 W JEFFERSON BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46804-6204 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245439140 | Alvarez Vision Services Inc | Optometrist | 6424 W Jefferson Blvd, Fort Wayne, IN 46804-6204 | 2007-07-12 |
| 1043380819 | Michael Owen Young | Optometrist | 6424 W Jefferson Blvd, Suite A, Fort Wayne, IN 46804-6204 | 2006-11-09 |
| 1487724258 | Michael O Young Od PC | Optometrist | 6424 W Jefferson Blvd, Suite A, Fort Wayne, IN 46804-6204 | 2006-11-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396350344 | Derek Mumaw | Physical Therapist | 8420 Illinois Rd, Fort Wayne, IN 46804 | 2020-09-15 |
| 1942840228 | Erin M Mason | Behavior Technician | 5601 Coventry Ln, Fort Wayne, IN 46804 | 2020-01-14 |
| 1346880879 | Emily A Abdalla | Behavior Technician | 5601 Coventry Ln., Fort Wayne, IN 46804 | 2020-01-13 |
| 1083265433 | Fort Wayne Endodontics | Dentist | 9407 Illinois Rd, Fort Wayne, IN 46804 | 2019-09-26 |
| 1689140949 | Harrison Dental Group II, LLC | Dentist | 1333 Getz Rd, Fort Wayne, IN 46804 | 2018-10-15 |
| 1346731908 | Erin Nicole Zimmerman | Nurse Practitioner | 10170 Illinois Rd # 14, Fort Wayne, IN 46804 | 2018-05-19 |
| 1417446022 | Mary Harrington | Physical Therapist | 3320 Copper Hill Run, Fort Wayne, IN 46804 | 2018-05-09 |
| 1942701214 | Joshawa Todd Torres | Marriage & Family Therapist | 5651 Coventry Ln # 116, Fort Wayne, IN 46804 | 2018-02-22 |
| 1194235408 | Mitchell Kory Meyer | Specialist/Technologist | 9125 Yellow Tree Ct, Fort Wayne, IN 46804 | 2017-10-02 |
| 1902324916 | Emily Rene Sagstetter | Specialist/Technologist | 6034 Liberty Glade Ct, Fort Wayne, IN 46804 | 2017-08-30 |
| Find all providers in zip 46804 | ||||
| Taxonomy Code | 332H00000X |
| Grouping | Suppliers |
| Classification | Eyewear Supplier (Equipment, not the service) |
| An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760993810 | Longe Enterprises Corp | Eyewear Supplier (Equipment, not the service) | 5711 Ymca Park Dr East, Fort Wayne, IN 46835 | 2017-10-17 |
| 1881927317 | Longe Optical-north Inc | Eyewear Supplier (Equipment, not the service) | 4534 Maplecrest Rd, Fort Wayne, IN 46835-3970 | 2009-09-16 |
| 1700932415 | National Vision, Inc. | Eyewear Supplier (Equipment, not the service) | 333 East Coliseum Boulevard, Fort Wayne, IN 46805 | 2007-01-26 |
| 1770667917 | Longe Optical | Eyewear Supplier (Equipment, not the service) | 7625 Southtown Crossing, Fort Wayne, IN 46816-2506 | 2006-10-24 |
| 1649293903 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 4201 Coldwater Road, Fort Wayne, IN 46805 | 2006-07-26 |
| 1205822145 | Tri-state Optical, Inc. | Eyewear Supplier (Equipment, not the service) | 5233 Coldwater Rd, Fort Wayne, IN 46825-5538 | 2005-09-26 |
| 1528584562 | Eyecare Express | Eyewear Supplier (Equipment, not the service) | 700 E Coliseum Blvd, Fort Wayne, IN 46805-1220 | 2017-08-22 |
| 1477944510 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 5110 Value Dr, Fort Wayne, IN 46808-4048 | 2015-02-11 |
| 1194123026 | Eyemart Express LLC | Eyewear Supplier (Equipment, not the service) | 515 E Coliseum Blvd, Fort Wayne, IN 46805-1215 | 2014-12-09 |
| 1013255884 | Usv Optical Inc. | Eyewear Supplier (Equipment, not the service) | 6309 Lima Rd, Fort Wayne, IN 46818-1425 | 2013-01-29 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46804 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.