Provider Demographics
NPI:1154381770
Name:TOSO, JONATHAN (OD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:TOSO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E 5TH ST
Mailing Address - Street 2:BOX 39
Mailing Address - City:CANTON
Mailing Address - State:SD
Mailing Address - Zip Code:57013-1731
Mailing Address - Country:US
Mailing Address - Phone:605-987-2841
Mailing Address - Fax:605-987-2810
Practice Address - Street 1:109 E 5TH ST
Practice Address - Street 2:BOX 39
Practice Address - City:CANTON
Practice Address - State:SD
Practice Address - Zip Code:57013-1731
Practice Address - Country:US
Practice Address - Phone:605-987-2841
Practice Address - Fax:605-987-2810
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD570152W00000X
IA2042152W00000X
MN2459152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU44402OtherUPIN
SD0040062OtherWELLMARK BC/BS
SD9201575Medicaid
SD40062Medicare UPIN