Healthcare Provider Details

I. General information

NPI: 1639178072
Provider Name (Legal Business Name): ALAN GREGORY TOLER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 09/05/2024
Certification Date: 09/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 WESTOVER HILLS BLVD
RICHMOND VA
23225-3109
US

IV. Provider business mailing address

1407 WESTOVER HILLS BLVD
RICHMOND VA
23225-3109
US

V. Phone/Fax

Practice location:
  • Phone: 804-231-9151
  • Fax: 804-231-9175
Mailing address:
  • Phone: 804-231-9151
  • Fax: 804-231-9175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000188
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: