Provider Demographics
NPI:1750354080
Name:SONNLEITNER, MICHAEL G (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:SONNLEITNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 - 41ST AVE
Mailing Address - Street 2:STE 108
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010
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:
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-2057
Practice Address - Country:US
Practice Address - Phone:831-476-7744
Practice Address - Fax:831-464-1515
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2012-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5209T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT09905Medicare UPIN