Healthcare Provider Details

I. General information

NPI: 1720175375
Provider Name (Legal Business Name): DEBORAH JOYCE SONNENMOSER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 10/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 MESCALERO TRL STE 1
RUIDOSO NM
88345-6089
US

IV. Provider business mailing address

159 MESCALERO TRL STE 1
RUIDOSO NM
88345-6089
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-5029
  • Fax: 575-257-9096
Mailing address:
  • Phone: 575-257-5029
  • Fax: 575-257-9096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number337
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: