=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467696922
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GARY L. TOST OD, LC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2009
-----------------------------------------------------
Last Update Date | 02/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3654 SW ARCHER RD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32608-2413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-264-0385
-----------------------------------------------------
Fax | 352-264-0386
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3654 SW ARCHER RD
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32608-2413
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-264-0385
-----------------------------------------------------
Fax | 352-264-0386
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | GARY L TOST
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 352-264-0385
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPC1698
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------