Provider Demographics
NPI:1861527079
Name:FAULKNER, WILLIAM DOUGLAS (OD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DOUGLAS
Last Name:FAULKNER
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 1:400 L ST
Mailing Address - Street 2:SUITE104
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99501-1925
Mailing Address - Country:US
Mailing Address - Phone:907-276-1984
Mailing Address - Fax:907-276-1981
Practice Address - Street 1:400 L ST
Practice Address - Street 2:SUITE104
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-1925
Practice Address - Country:US
Practice Address - Phone:907-276-1984
Practice Address - Fax:907-276-1981
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK77152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKKOOOOPHFTNMedicare ID - Type Unspecified
AKU19273Medicare UPIN