Provider Demographics
NPI:1689442378
Name:SUNDBERG, ERIC JOHN (LDO)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:SUNDBERG
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2793 TAYLOR ROAD EXT
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-9549
Mailing Address - Country:US
Mailing Address - Phone:614-367-1025
Mailing Address - Fax:614-367-1028
Practice Address - Street 1:2793 TAYLOR ROAD EXT
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-9549
Practice Address - Country:US
Practice Address - Phone:614-367-1025
Practice Address - Fax:614-367-1028
Is Sole Proprietor?:No
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.017588-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician