Organization
TRISTATE OPTICAL, INC.
Active
Other names
Cunningham Optical One
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY L BRADLEY (VICE PRESIDENT)
(260) 436-2020
Entity
Organization
Contact information
Practice address
6424 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6204
(260) 436-2020
(260) 436-7628
Mailing address
6424 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6204
(260) 436-2020
(260) 436-7628
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
—
—
Other
Enumeration date
09/26/2005
Last updated
08/22/2020
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