MEDICARE: DR. 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	004514-1	NY
2	152W00000X	Optometrist	OEG003475	PA

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)	:	DR. GARY MICHAEL PISANCHYN OD

Provider Business Mailing Address
First Line	:	530 COLUMBIA DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-3300
Country	:	US
Telephone Number	:	607-729-5016
Fax Number	:	607-729-7574

Provider Business Practice Location Address
First Line	:	530 COLUMBIA DR
Second Line	:
City	:	JOHNSON CITY
State	:	NY
Zip	:	13790-3300
Country	:	US
Telephone Number	:	607-729-5016
Fax Number	:	607-729-7574

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

Provider Enumeration Date	:	05/30/2006
Last Update Date	:	09/26/2025

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