Provider Demographics
NPI:1033102314
Name:DRS. GUTOWSKI & SONNENMOSER
Entity Type:Organization
Organization Name:DRS. GUTOWSKI & SONNENMOSER
Other - Org Name:FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SONNENMOSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:575-257-5029
Mailing Address - Street 1:159 MESCALERO TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6089
Mailing Address - Country:US
Mailing Address - Phone:575-257-5029
Mailing Address - Fax:575-257-9096
Practice Address - Street 1:159 MESCALERO TRL STE 1
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6089
Practice Address - Country:US
Practice Address - Phone:575-257-5029
Practice Address - Fax:575-257-9096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME9156Medicaid
NME8076Medicaid
NME8076Medicaid
NM2590217Medicare UPIN
NM0278710001Medicare NSC
NM2590134Medicare UPIN