Provider Demographics
NPI:1326036385
Name:DISTLER, JOHN A (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:DISTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6400 WESTWIND WAY
Mailing Address - Street 2:
Mailing Address - City:CRESTWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:40014-6773
Mailing Address - Country:US
Mailing Address - Phone:502-243-2227
Mailing Address - Fax:502-243-2237
Practice Address - Street 1:6400 WESTWIND WAY
Practice Address - Street 2:
Practice Address - City:CRESTWOOD
Practice Address - State:KY
Practice Address - Zip Code:40014-6773
Practice Address - Country:US
Practice Address - Phone:502-243-2227
Practice Address - Fax:502-243-2237
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KYAD1776369207W00000X
KY24245207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY180033886OtherMEDICARE RAILROAD
KY1177630003OtherMEDICARE DME MAC
KY64242456Medicaid
KY1177630003OtherMEDICARE DME MAC
B82194Medicare UPIN