CUNNINGHAM OPTICAL ONE
NPI 1013903962
Eyewear Supplier in Fort Wayne, IN
About Cunningham Optical One NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CUNNINGHAM OPTICAL ONE (NPI 1013903962) is a healthcare organization registered as an eyewear supplier in Fort Wayne, Indiana and active in the NPI registry since September 2005. The organization lists Jerry L Bradley, Vice President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and revalidation status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Cunningham Optical One is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Other Providers at the Same Location NPPES 4
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Tristate Optical, Inc.'s NPI number?
The NPI number for Tristate Optical, Inc. is 1013903962. It was assigned to this organization in the NPPES registry on September 26, 2005. The provider is doing business as Cunningham Optical One.
Where is Tristate Optical, Inc. located?
Tristate Optical, Inc. is located at 6424 W Jefferson Blvd, Fort Wayne, IN 46804. The listed phone number is (260) 436-2020.
What is Tristate Optical, Inc.'s specialty?
The primary specialty registered for this NPI is Eyewear Supplier with taxonomy code 332H00000X.
Is Tristate Optical, Inc. enrolled in Medicare?
Yes. Tristate Optical, Inc. is registered in the Medicare PECOS enrollment system.
When is Tristate Optical, Inc.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare DME enrollment for this organization (Indiana, Optician) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
When was this NPI record last updated?
The NPPES record for Tristate Optical, Inc. was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Cunningham Optical One · NPI 1013903962
Eyewear Supplier organization in Fort Wayne, Indiana. Organization record, active in the CMS NPPES registry since September 26, 2005.
## Identity
- **NPI:** 1013903962 (Entity type: Organization)
- **Enumerated:** September 26, 2005
- **Primary specialty:** Eyewear Supplier · taxonomy 332H00000X
- **Legal business name:** Tristate Optical, Inc.
- **Organization subpart:** No
- **Authorized official:** Jerry Bradley, VICE PRESIDENT
## Practice location
- **Address:** 6424 W JEFFERSON BLVD, Fort Wayne, IN 46804-6204
- **Phone:** (260) 436-2020 · **Fax:** (260) 436-7628
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (DME, Indiana, Optician) · CMS Revalidation Due Date List, October 2026 release
## Record status
- **NPPES last updated:** August 22, 2020
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Source: [NPI Profile](https://npiprofile.com/npi/1013903962) · Data from the CMS NPPES public registry.