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General NPI Number Information
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NPI Number | 1093034605
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Entity Type | Organization
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Legal Business Name | DISTLER, HUNTINGTON & BLAIR, PSC
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 6400 WESTWIND WAY
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City | CRESTWOOD
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State | KY
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Zip | 40014-6773
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Country | US
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Telephone | 502-243-2257
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Fax |
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Provider Business Mailing Address
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Address Line | 6400 WESTWIND WAY
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City | CRESTWOOD
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State | KY
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Zip | 40014-6773
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. SUZANNE YATES
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Credential |
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Telephone | 502-243-2257
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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