Provider Demographics
NPI:1780725994
Name:PENSAK, MARC M (OD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:M
Last Name:PENSAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1743 N KEYSER AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18508-1261
Mailing Address - Country:US
Mailing Address - Phone:570-961-1400
Mailing Address - Fax:570-961-0744
Practice Address - Street 1:1743 N KEYSER AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18508-1261
Practice Address - Country:US
Practice Address - Phone:570-961-1400
Practice Address - Fax:570-961-0744
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE006491P PA152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30545Medicare UPIN