Healthcare Provider Details

I. General information

NPI: 1437375029
Provider Name (Legal Business Name): DRS. DISTIN & DOYLE, OPTOMETRISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 PUBLIC SQ
MONMOUTH IL
61462-1755
US

IV. Provider business mailing address

67 PUBLIC SQ
MONMOUTH IL
61462-1755
US

V. Phone/Fax

Practice location:
  • Phone: 309-734-3108
  • Fax: 309-734-6988
Mailing address:
  • Phone: 309-734-3108
  • Fax: 309-734-6988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberEACH DR HAS LICENSE
License Number StateIL

VIII. Authorized Official

Name: MARY G DISTIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 309-734-3108