Provider Demographics
NPI:1720491277
Name:PANCOTT, BRENDAN (OD)
Entity Type:Individual
Prefix:DR
First Name:BRENDAN
Middle Name:
Last Name:PANCOTT
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 1:436 ARDSLEY PL
Mailing Address - Street 2:
Mailing Address - City:GLENMOORE
Mailing Address - State:PA
Mailing Address - Zip Code:19343-2674
Mailing Address - Country:US
Mailing Address - Phone:610-329-4360
Mailing Address - Fax:
Practice Address - Street 1:1800 LOUCKS RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-4609
Practice Address - Country:US
Practice Address - Phone:717-764-1485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002913152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist