MEDICARE: DR. EDWARD BANCROFT O. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	119	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184725202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD BANCROFT O. D.

Provider Business Mailing Address
First Line	:	4045 LAKE OTIS PKWY
Second Line	:	STE 203
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5227
Country	:	US
Telephone Number	:	907-562-2020
Fax Number	:	907-563-4821

Provider Business Practice Location Address
First Line	:	4045 LAKE OTIS PKWY
Second Line	:	STE 203
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5227
Country	:	US
Telephone Number	:	907-562-2020
Fax Number	:	907-563-4821

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	11/25/2008

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