NPI 1013903962

Tristate Optical, INC.

Organisation Eyewear Supplier Fort Wayne, IN

Practice location

Address: 6424 W Jefferson Blvd, Fort Wayne, IN 46804-6204
Phone: (260) 436-2020
Fax: (260) 436-7628

Authorised official

Name: Jerry L Bradley
Title: Vice President
Phone: (260) 436-2020

Registered specialties

Eyewear Supplier Primary

Suppliers Taxonomy 332H00000X

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Registry record

NPI: 1013903962
Entity type: Organization
NPI issued: 26 Sep 2005
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.