TRI-STATE OPTICAL, INC.

NPI: 1205822145 · FORT WAYNE, IN 46825 · Eyewear Supplier · NPI assigned 09/26/2005

$1.22M

Total Medicaid Paid

37,521

Total Claims

33,543

Beneficiaries

Codes Billed

2018-01

First Month

2024-12

Last Month

Provider Details

Authorized Official	BRADLEY, JERRY (VICE PRESIDENT)
NPI Enumeration Date	09/26/2005

Other providers sharing the same authorized official: BRADLEY, JERRY

Provider	City	State	Total Paid
JERRY BRADLEY DDS AND ASSOCIATES PLLC	EDENTON	NC	$2.08M
TRISTATE OPTICAL, INC.	WARSAW	IN	$247K
TRISTATE OPTICAL, INC.	FORT WAYNE	IN	$198K

Code	Description	Claims	Beneficiaries	Total Paid
V2020	Frames, purchases	11,957	10,731	$432K
V2103	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	6,791	6,123	$283K
V2755	U-v lens, per lens	10,206	9,274	$174K
V2203	Spherocylinder, bifocal, plano to plus or minus 4.00d sphere, .12 to 2.00d cylinder, per lens	1,880	1,683	$118K
V2730	Special base curve, glass or plastic, per lens	2,838	2,418	$78K
V2100	Sphere, single vision, plano to plus or minus 4.00, per lens	1,540	1,354	$51K
V2784	Lens, polycarbonate or equal, any index, per lens	971	796	$29K
V2104	Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens	574	530	$25K
V2107	Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00 sphere, .12 to 2.00d cylinder, per lens	539	460	$21K
V2200	Sphere, bifocal, plano to plus or minus 4.00d, per lens	213	162	$13K
V2744	Tint, photochromatic, per lens	12	12	$0.00