Provider Demographics
NPI:1245409036
Name:SORENSEN, DEBRA M (OD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:M
Last Name:SORENSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:M
Other - Last Name:DEAGOSTINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2655 WHEATON WAY
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310
Mailing Address - Country:US
Mailing Address - Phone:360-377-3703
Mailing Address - Fax:360-377-9469
Practice Address - Street 1:2655 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310
Practice Address - Country:US
Practice Address - Phone:360-377-3703
Practice Address - Fax:360-377-9469
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0D0000385152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8879152Medicare PIN