Provider Demographics
NPI:1629047840
Name:PISACANO, DANIEL G (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:G
Last Name:PISACANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9602 DUNDERRY HTS
Mailing Address - Street 2:
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-9082
Mailing Address - Country:US
Mailing Address - Phone:315-720-3988
Mailing Address - Fax:
Practice Address - Street 1:341 STATE ROUTE 104
Practice Address - Street 2:VISION CENTER
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-2911
Practice Address - Country:US
Practice Address - Phone:315-207-7044
Practice Address - Fax:315-343-5165
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2016-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT 6120152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU75579Medicare UPIN
NJU75579Medicare UPIN