Organization Active NPI

Gary Toler

Doing business as Willie's Specialty Shop

  • Durable Medical Equipment & Medical Supplies
  • Orange, CA
National Provider Identifier
1417088899
Registry record updated Aug 27, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
I-105963-L Issued in CA
Legal business name
GARY TOLER
Doing business as
Willie's Specialty Shop
Practice address
392 S Tustin St
Orange, CA 92866-2502
Phone
(714) 771-4310
NPI assigned
Mar 8, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gary Paul TolerNPI 1780866780
Title
Owner
Phone
(714) 771-4312

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X I-105963-L CA Primary

Addresses

Primary practice location

392 S Tustin St
Orange, CA 92866-2502

Mailing address

392 S Tustin St
Orange, CA 92866-2502
Phone (714) 771-4310

Other names 1

  • Willie's Specialty Shop Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Willie's Specialty Shop392 S Tustin St, Orange, CA 92866-2502(714) 771-4310 Breast Prostheses and/or Accessories|Lymphedema Compression Treatment Items Does not accept assignmentParticipating since Jan 1, 2013

National Provider Directory

National Provider Directory

Locations

392 S Tustin St
Orange, CA 92866
Phone (714) 771-4310

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188172800000",
    "number": "1417088899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "392 S TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928662502",
            "telephone_number": "714-771-4310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "392 S TUSTIN ST",
            "city": "ORANGE",
            "state": "CA",
            "postal_code": "928662502",
            "telephone_number": "714-771-4310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY TOLER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-08-27",
        "status": "A",
        "authorized_official_last_name": "TOLER",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "714-771-4312"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "CA",
            "license": "I-105963-L",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willie's Specialty Shop",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Orange, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.