Individual
GARY PESICKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5323 HARRY HINES BLVD, DALLAS, TX 75390-7208
(214) 645-2020
Mailing address
PO BOX 845347, DALLAS, TX 75284-5347
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
28979
WI
207W00000X
Ophthalmology Physician
Primary
43812
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31375900
—
WI
Enumeration date
08/21/2006
Last updated
11/07/2013
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