Provider Demographics
NPI:1568573350
Name:TRI-STATE VISION CENTER, INC.
Entity Type:Organization
Organization Name:TRI-STATE VISION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:R
Authorized Official - Last Name:KUNSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-485-4257
Mailing Address - Street 1:306 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:OH
Mailing Address - Zip Code:43543-1018
Mailing Address - Country:US
Mailing Address - Phone:419-485-4257
Mailing Address - Fax:419-485-3520
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:OH
Practice Address - Zip Code:43543-1018
Practice Address - Country:US
Practice Address - Phone:419-485-4257
Practice Address - Fax:419-485-3520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5049152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0090982Medicaid
OH0090982Medicaid
OH0235340001Medicare NSC
OHKU4110303Medicare PIN
OHP00291522Medicare PIN
OHDE4179Medicare PIN