Provider Demographics
NPI:1962432401
Name:SOSIS, CHARLES B (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:B
Last Name:SOSIS
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:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08754-0383
Mailing Address - Country:US
Mailing Address - Phone:732-240-0020
Mailing Address - Fax:732-341-2029
Practice Address - Street 1:OAK RIDGE PKWY AND CARDINAL DR
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08754-0383
Practice Address - Country:US
Practice Address - Phone:732-240-0020
Practice Address - Fax:732-341-2029
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2937152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
3683DOtherDAVIS VIS
86715OtherSPECTERA
NJ0709603Medicaid
86715OtherSPECTERA
3683DOtherDAVIS VIS