Provider Demographics
NPI:1457482739
Name:MICHAEL G SONNLEITNER
Entity Type:Organization
Organization Name:MICHAEL G SONNLEITNER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:G
Authorized Official - Last Name:SONNLEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:831-476-7744
Mailing Address - Street 1:2121 41ST AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2056
Mailing Address - Country:US
Mailing Address - Phone:831-476-7744
Mailing Address - Fax:831-464-1515
Practice Address - Street 1:2121 41ST AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2056
Practice Address - Country:US
Practice Address - Phone:831-476-7744
Practice Address - Fax:831-464-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5209T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT09905Medicare UPIN