Provider Demographics
NPI:1285629485
Name:TOSLAND, DALE L (OD)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:L
Last Name:TOSLAND
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 1:1625 COOPER POINT RD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5735
Mailing Address - Country:US
Mailing Address - Phone:360-357-6683
Mailing Address - Fax:360-754-0482
Practice Address - Street 1:1625 COOPER POINT RD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5735
Practice Address - Country:US
Practice Address - Phone:360-357-6683
Practice Address - Fax:360-754-0482
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1574TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2014488Medicaid
WAAB22894Medicare UPIN
WA2014488Medicaid