Provider Demographics
NPI:1033242375
Name:VALENTINE VISION CENTER INC
Entity Type:Organization
Organization Name:VALENTINE VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BANCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:402-376-2020
Mailing Address - Street 1:318 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VALENTINE
Mailing Address - State:NE
Mailing Address - Zip Code:69201-1842
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:318 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VALENTINE
Practice Address - State:NE
Practice Address - Zip Code:69201-1842
Practice Address - Country:US
Practice Address - Phone:402-376-2020
Practice Address - Fax:402-376-1652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
229986OtherMIDLANDS CHOICE
SD9200950Medicaid
NE06790OtherBLUE CROSS BLUE SHIELD
410011000OtherTRAVELERS
229986OtherMIDLANDS CHOICE
NE=========00Medicaid
NE093913Medicare PIN