Individual
GARY D DISTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
67 PUBLIC SQ, MONMOUTH, IL 61462-1755
(309) 734-3108
(309) 734-6988
Mailing address
67 PUBLIC SQ, MONMOUTH, IL 61462-1755
(309) 734-3108
(309) 734-6988
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046006527
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046006527
—
IL
Enumeration date
09/19/2005
Last updated
05/25/2010
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