Individual
DR. JOHN A. DISTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6400 WESTWIND WAY, CRESTWOOD, KY 40014-6773
(502) 243-2227
(502) 243-2237
Mailing address
6400 WESTWIND WAY, CRESTWOOD, KY 40014-6773
(502) 243-2227
(502) 243-2237
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
24245
KY
207W00000X
Ophthalmology Physician
AD1776369
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1177630003
MEDICARE DME MAC
KY
01
—
180033886
MEDICARE RAILROAD
KY
05
—
64242456
—
KY
Enumeration date
10/12/2005
Last updated
02/20/2015
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