NPIMap

Organization Active NPI

Olympia Vision Clinic and Contact Lens Center, PLLC

  • Optometrist
  • Olympia, WA
National Provider Identifier
1962544692
Registry record updated Jun 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
OLYMPIA VISION CLINIC AND CONTACT LENS CENTER, PLLC
Practice address
1625 Cooper Point Rd SW
Olympia, WA 98502-5735
Phone
(360) 357-6683
Fax
(360) 754-0482
NPI assigned
Feb 12, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2023

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

Authorized official

Name
Dr. Dale Leroy Tosland, O.D.
Title
Owner
Phone
(360) 357-6683

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

1625 Cooper Point Rd SW
Olympia, WA 98502-5735

Mailing address

1625 Cooper Point Rd SW
Olympia, WA 98502-5735
Phone (360) 357-6683

Other practice location 1

10217 19th Ave SE Ste 102
Everett, WA 98208-4266
Phone (425) 316-9400

Other identifiers 4

IdentifierTypeStateIssuer
2031011MedicaidWA
4576KOOtherWAREGENCE RIDER NUMBER
201448MedicaidWA
TO5614OtherWAREGENCE RIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040402000888 WA Part B Supplier - Clinic/Group Practice 8820080237 Receives reassigned benefits from 13 practitioners
Practice locations: Everett, WA; Lacey, WA; Olympia, WA

National Provider Directory

National Provider Directory

Locations

10217 19th Ave SE
Ste 102
Everett, WA 98208
Phone (425) 316-9400

1625 Cooper Point Rd SW
Olympia, WA 98502
Phone (360) 357-6683

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687392000000",
    "number": "1962544692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 COOPER POINT RD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025735",
            "telephone_number": "360-357-6683",
            "fax_number": "360-754-0482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 COOPER POINT RD SW",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985025735",
            "telephone_number": "360-357-6683",
            "fax_number": "360-754-0482"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10217 19th Ave SE Ste 102",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982084266",
            "country_code": "US",
            "telephone_number": "425-316-9400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "OLYMPIA VISION CLINIC AND CONTACT LENS CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-12",
        "last_updated": "2023-06-22",
        "certification_date": "2023-06-22",
        "status": "A",
        "authorized_official_last_name": "TOSLAND",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "LEROY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-357-6683",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2031011",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE RIDER NUMBER",
            "identifier": "4576KO",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201448",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE RIDER NUMBER",
            "identifier": "TO5614",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Olympia, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.