MEDICARE: DR. JOHN A. DISTLER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	AD1776369	KY
2	207W00000X	Ophthalmology Physician	24245	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	180033886	OTHER	KY	MEDICARE RAILROAD
2	1177630003	OTHER	KY	MEDICARE DME MAC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326036385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN A. DISTLER MD

Provider Business Mailing Address
First Line	:	6400 WESTWIND WAY
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-6773
Country	:	US
Telephone Number	:	502-243-2227
Fax Number	:	502-243-2237

Provider Business Practice Location Address
First Line	:	6400 WESTWIND WAY
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-6773
Country	:	US
Telephone Number	:	502-243-2227
Fax Number	:	502-243-2237

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	02/20/2015

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Directions to “ DR. JOHN A. DISTLER MD” Practice Location

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