Healthcare Provider Details

I. General information

NPI: 1033242375
Provider Name (Legal Business Name): VALENTINE VISION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 N MAIN ST
VALENTINE NE
69201-1842
US

IV. Provider business mailing address

318 N MAIN ST
VALENTINE NE
69201-1842
US

V. Phone/Fax

Practice location:
  • Phone: 402-376-2020
  • Fax: 402-376-1652
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: CALVIN K BANCROFT
Title or Position: OWNER
Credential: O.D.
Phone: 402-376-2020