Healthcare Provider Details

I. General information

NPI: 1750354080
Provider Name (Legal Business Name): MICHAEL G SONNLEITNER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 05/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 41ST AVE
CAPITOLA CA
95010-2057
US

IV. Provider business mailing address

2121 - 41ST AVE STE 108
CAPITOLA CA
95010
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:
Title or Position:
Credential:
Phone: