Provider Demographics
NPI:1851951362
Name:WYLER, CHRISTIAN MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:MATTHEW
Last Name:WYLER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:103 NEWIGI DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:KY
Mailing Address - Zip Code:40484-1309
Mailing Address - Country:US
Mailing Address - Phone:859-339-8011
Mailing Address - Fax:
Practice Address - Street 1:304 STANFORD ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444
Practice Address - Country:US
Practice Address - Phone:859-304-5224
Practice Address - Fax:859-304-5227
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2137DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist