Healthcare Provider Details

I. General information

NPI: 1942357652
Provider Name (Legal Business Name): TRI STATE OPTICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 MARSHALL ST SUITE 2
COLDWATER MI
49036-1175
US

IV. Provider business mailing address

350 MARSHALL ST SUITE 2
COLDWATER MI
49036-1175
US

V. Phone/Fax

Practice location:
  • Phone: 517-279-7951
  • Fax: 517-279-8000
Mailing address:
  • Phone: 517-279-7951
  • Fax: 517-279-8000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MR. DANIEL JEROME CASEY
Title or Position: GENERAL MANAGER
Credential: A.B.O.C.
Phone: 517-279-7951