MEDICARE: DISTLER, HUNTINGTON & BLAIR PSC

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

Other Identifiers

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

General Provider Information

NPI Number	:	1972652998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DISTLER, HUNTINGTON & BLAIR PSC

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	:	502-367-4020

Authorized Official
Title or Position	:	MD/OWNER
Name	:	BRYAN M. BLAIR
Credential	:
Telephone Number	:	502-243-2227

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/05/2014

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