MEDICARE: DR. THERESA SOKOLOWSKI O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OA005354	NJ

General Provider Information

NPI Number	:	1578562906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERESA SOKOLOWSKI O.D.

Provider Business Mailing Address
First Line	:	23 DEAN RD
Second Line	:
City	:	MENDHAM
State	:	NJ
Zip	:	07945-1627
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1240 SUSSEX TPKE
Second Line	:	SUITE 4
City	:	RANDOLPH
State	:	NJ
Zip	:	07869-2944
Country	:	US
Telephone Number	:	973-895-9292
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/09/2007

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