Healthcare Provider Details

I. General information

NPI: 1053106013
Provider Name (Legal Business Name): CHRISTOPHER JAMES DISTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1689 NONCONNAH BLVD
MEMPHIS TN
38132-2105
US

IV. Provider business mailing address

1689 NONCONNAH BLVD
MEMPHIS TN
38132-2105
US

V. Phone/Fax

Practice location:
  • Phone: 901-271-4900
  • Fax:
Mailing address:
  • Phone: 901-271-4900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number255038
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: