Healthcare Provider Details

I. General information

NPI: 1245962760
Provider Name (Legal Business Name): DANE TOSLAND
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 LINCOLN WAY
COEUR D ALENE ID
83814-2540
US

IV. Provider business mailing address

1814 LINCOLN WAY
COEUR D ALENE ID
83814-2540
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-2531
  • Fax:
Mailing address:
  • Phone: 208-667-2531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2771980
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: