Provider Demographics
NPI:1598862294
Name:GANSARSKI, MARY F (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:F
Last Name:GANSARSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:F
Other - Last Name:GANSARSKI-WAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:128 LAYTON LN
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15904-4018
Mailing Address - Country:US
Mailing Address - Phone:814-269-2157
Mailing Address - Fax:814-949-8993
Practice Address - Street 1:2600 OLD ROUTE 220 N
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-9328
Practice Address - Country:US
Practice Address - Phone:814-944-9888
Practice Address - Fax:814-949-8993
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET-008941152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0070878370002Medicaid
PA0070878370002Medicaid
PA441313Medicare ID - Type Unspecified