Healthcare Provider Details

I. General information

NPI: 1578783411
Provider Name (Legal Business Name): WILLIAM C SUNDBERG CPO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 10/05/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5660 B STREET
ANCHORAGE AK
99518-1641
US

IV. Provider business mailing address

PO BOX 110510
ANCHORAGE AK
99511
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-0560
  • Fax: 907-562-1617
Mailing address:
  • Phone: 907-562-0560
  • Fax: 907-562-1617

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateAK
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: