Healthcare Provider Details

I. General information

NPI: 1366464109
Provider Name (Legal Business Name): JOSEPH REED TOLER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 11/05/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9231 AMELIA ST
AMELIA VA
23002-0000
US

IV. Provider business mailing address

5640 RIVERSIDE DR
RICHMOND VA
23225-2536
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-3937
  • Fax:
Mailing address:
  • Phone: 804-387-6918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number0618000415
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: