Provider Demographics
NPI:1578783411
Name:SUNDBERG, WILLIAM C (CPO)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:SUNDBERG
Suffix:
Gender:M
Credentials:CPO
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 110510
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99511
Mailing Address - Country:US
Mailing Address - Phone:907-562-0560
Mailing Address - Fax:907-562-1617
Practice Address - Street 1:5660 B STREET
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99518-1641
Practice Address - Country:US
Practice Address - Phone:907-562-0560
Practice Address - Fax:907-562-1617
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
222Z00000X, 224P00000X
AK335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPO4558Medicaid
AKPO4558Medicaid