Provider Demographics
NPI:1073504726
Name:BANCROFT, CALVIN K (OD)
Entity Type:Individual
Prefix:DR
First Name:CALVIN
Middle Name:K
Last Name:BANCROFT
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 1:318 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:402-376-2020
Mailing Address - Fax:402-376-1652
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
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE776152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47069297700Medicaid
229986OtherMIDLANDS CHOICE
NE06790OtherBLUE CROSS BLUE SHIELD
SD9200950OtherSOUTH DAKOTA MEDICAID
229986OtherMIDLANDS CHOICE
NE47069297700Medicaid