Provider Demographics
NPI:1720175375
Name:SONNENMOSER, DEBORAH JOYCE (OD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:JOYCE
Last Name:SONNENMOSER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME8076Medicaid
NME9156Medicaid
NM410032284OtherRAIL RAOD MEDICARE
NM850335060Medicare PIN
NM410032284OtherRAIL RAOD MEDICARE
NM0278710001Medicare NSC