MEDICARE: GARY MICHAEL PISANCHYN OD

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	OEG003475	PA
2	152W00000X	Optometrist	004514-1	NY

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

General Provider Information

NPI Number	:	1598712846
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY MICHAEL PISANCHYN OD

Provider Business Mailing Address
First Line	:	2661 RIVA RD STE 1030
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21401-7131
Country	:	US
Telephone Number	:	667-354-5528
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 S STATE ST
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-1557
Country	:	US
Telephone Number	:	570-587-5186
Fax Number	:

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	03/25/2026

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