Healthcare Provider Details

I. General information

NPI: 1427050343
Provider Name (Legal Business Name): JOSEPH GREG TOLAND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W 3RD ST
POWELL WY
82435-2321
US

IV. Provider business mailing address

PO BOX 231
POWELL WY
82435-0231
US

V. Phone/Fax

Practice location:
  • Phone: 307-754-7151
  • Fax: 307-754-4261
Mailing address:
  • Phone: 307-754-7151
  • Fax: 307-754-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number167T
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: