Provider Demographics
NPI:1184725202
Name:BANCROFT, EDWARD (O D)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:
Last Name:BANCROFT
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4045 LAKE OTIS PKWY
Mailing Address - Street 2:STE 203
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5227
Mailing Address - Country:US
Mailing Address - Phone:907-562-2020
Mailing Address - Fax:907-563-4821
Practice Address - Street 1:4045 LAKE OTIS PKWY
Practice Address - Street 2:STE 203
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5227
Practice Address - Country:US
Practice Address - Phone:907-562-2020
Practice Address - Fax:907-563-4821
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKOD1190Medicaid
AKOP1190Medicaid
AKOD1190Medicaid
AKT66983Medicare UPIN