Healthcare Provider Details

I. General information

NPI: 1073504726
Provider Name (Legal Business Name): CALVIN K BANCROFT OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 11/27/2007
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: 402-376-2020
  • Fax: 402-376-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number776
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: