MEDICARE: DR. JOSEPH GREG TOLAND O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist	167T	WY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	313003	OTHER	WY	BC/BS
4	P00115325	OTHER	WY	PALMETTO GBA - PROVIDER

General Provider Information

NPI Number	:	1427050343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH GREG TOLAND O.D.

Provider Business Mailing Address
First Line	:	PO BOX 231
Second Line	:
City	:	POWELL
State	:	WY
Zip	:	82435-0231
Country	:	US
Telephone Number	:	307-754-7151
Fax Number	:	307-754-4261

Provider Business Practice Location Address
First Line	:	255 W 3RD ST
Second Line	:
City	:	POWELL
State	:	WY
Zip	:	82435-2321
Country	:	US
Telephone Number	:	307-754-7151
Fax Number	:	307-754-4261

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	05/21/2014

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