Individual
GARY MICHAEL PISANCHYN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
503 S STATE ST, CLARKS SUMMIT, PA 18411-1557
(570) 587-5186
Mailing address
2661 RIVA RD STE 1030, ANNAPOLIS, MD 21401-7131
(667) 354-5528
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
004514-1
NY
152W00000X
Optometrist
OEG003475
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00974465
—
NY
Enumeration date
05/30/2006
Last updated
03/25/2026
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