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General NPI Number Information
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NPI Number | 1962544692
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Entity Type | Organization
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Legal Business Name | OLYMPIA VISION CLINIC AND CONTACT LENS CENTER, PLLC
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 1625 COOPER POINT RD SW
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City | OLYMPIA
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State | WA
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Zip | 98502-5735
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Country | US
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Telephone | 360-357-6683
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Fax | 360-754-0482
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Provider Business Mailing Address
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Address Line | 1625 COOPER POINT RD SW
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City | OLYMPIA
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State | WA
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Zip | 98502-5735
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Country | US
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Telephone | 360-357-6683
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Fax | 360-754-0482
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Authorized Official
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Title or Position | OWNER
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Name | DR. DALE LEROY TOSLAND
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Credential | O.D.
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Telephone | 360-357-6683
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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