Provider Demographics
NPI:1427050343
Name:TOLAND, JOSEPH GREG (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:GREG
Last Name:TOLAND
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:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:WY
Mailing Address - Zip Code:82435-0231
Mailing Address - Country:US
Mailing Address - Phone:307-754-7151
Mailing Address - Fax:307-754-4261
Practice Address - Street 1:255 W 3RD ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:WY
Practice Address - Zip Code:82435-2321
Practice Address - Country:US
Practice Address - Phone:307-754-7151
Practice Address - Fax:307-754-4261
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY167T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104233500Medicaid
WY120171900Medicaid
WY313003OtherBC/BS
WYP00115325OtherPALMETTO GBA - PROVIDER
WYDB5764Medicare PIN
WY313003OtherBC/BS
WYT44162Medicare UPIN
WY120171900Medicaid