=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043591951
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DR ALLISON TOLER AND ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2011
-----------------------------------------------------
Last Update Date | 07/05/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2660 E HIGHWAY 50
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34711-6034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-241-6777
-----------------------------------------------------
Fax | 352-394-1762
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 121219
-----------------------------------------------------
City | CLERMONT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34712-1219
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-241-6777
-----------------------------------------------------
Fax | 352-394-1762
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. ALLISON TOLER
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 352-241-6777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC3837
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------