Provider Demographics
NPI:1093940686
Name:CARLETON, SONJA PATRICIA (OP)
Entity Type:Individual
Prefix:MRS
First Name:SONJA
Middle Name:PATRICIA
Last Name:CARLETON
Suffix:
Gender:F
Credentials:OP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:NH
Mailing Address - Zip Code:03773-0148
Mailing Address - Country:US
Mailing Address - Phone:603-863-7770
Mailing Address - Fax:603-863-7248
Practice Address - Street 1:57 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:NH
Practice Address - Zip Code:03773-1519
Practice Address - Country:US
Practice Address - Phone:603-863-7770
Practice Address - Fax:603-863-7248
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHNH0457156FC0801X, 156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1017998Medicaid
NH30757583Medicaid