Provider Demographics
NPI:1639178072
Name:TOLER, ALAN GREGORY (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:GREGORY
Last Name:TOLER
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 1:1407 WESTOVER HILLS BLVD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3109
Mailing Address - Country:US
Mailing Address - Phone:804-231-9151
Mailing Address - Fax:804-231-9175
Practice Address - Street 1:1407 WESTOVER HILLS BLVD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-3109
Practice Address - Country:US
Practice Address - Phone:804-231-9151
Practice Address - Fax:804-231-9175
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0351170002OtherDME POS ASSIGNED MEDICARE
22-00139OtherUNITED HEALTHCARE
436185OtherMAMSI
VA92-4258-9Medicaid
068258OtherANTHEM BCBS
068261OtherANTHEM BCBS
5072484OtherCIGNA
VA410000392Medicare ID - Type Unspecified
VA410019925Medicare PIN
5072484OtherCIGNA
VA410000711Medicare ID - Type Unspecified