Healthcare Provider Details

I. General information

NPI: 1457482739
Provider Name (Legal Business Name): MICHAEL G SONNLEITNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 41ST AVE SUITE 108
CAPITOLA CA
95010-2056
US

IV. Provider business mailing address

2121 41ST AVE SUITE 108
CAPITOLA CA
95010-2056
US

V. Phone/Fax

Practice location:
  • Phone: 831-476-7744
  • Fax: 831-464-1515
Mailing address:
  • Phone: 831-476-7744
  • Fax: 831-464-1515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5209T
License Number StateCA

VIII. Authorized Official

Name: DR. MICHAEL G. SONNLEITNER
Title or Position: OWNER
Credential: O.D.
Phone: 831-476-7744