Provider Demographics
NPI:1821307992
Name:LOSINSKI, TRACY ANN (OD)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:ANN
Last Name:LOSINSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 HOOPER AVE
Mailing Address - Street 2:SPACE 1045-46
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3330
Mailing Address - Country:US
Mailing Address - Phone:732-240-2077
Mailing Address - Fax:732-240-2410
Practice Address - Street 1:1201 HOOPER AVE
Practice Address - Street 2:SPACE 1045-46
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3330
Practice Address - Country:US
Practice Address - Phone:732-240-2077
Practice Address - Fax:732-240-2410
Is Sole Proprietor?:No
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00626900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist