Gary D Distin, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

046006527 Issued in IL

Practice address

67 Public SQ
Monmouth, IL 61462-1755

Phone

(309) 734-3108

Fax

(309) 734-6988

NPI assigned

Sep 19, 2005

Last updated

May 25, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1274745600000",
    "number": "1477548287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "67 PUBLIC SQ",
            "city": "MONMOUTH",
            "state": "IL",
            "postal_code": "614621755",
            "telephone_number": "309-734-3108",
            "fax_number": "309-734-6988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 PUBLIC SQ",
            "city": "MONMOUTH",
            "state": "IL",
            "postal_code": "614621755",
            "telephone_number": "309-734-3108",
            "fax_number": "309-734-6988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTIN",
        "first_name": "GARY",
        "middle_name": "D",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-19",
        "last_updated": "2010-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046006527",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Craig Cozadd
• DC3 Pharmacy Partners Inc (Warren County Pharmacy)
• Susan Denecke
• Ruth L Dennis, MHP,RN
• Jenna Bianca Batara Dionisio, D.O.
• Daniel R Doyle, OD
• Dr Byung Il Hyun MD
• Sarah Elizabeth Dravis, PHARMD, RPH
• DRS. Distin & Doyle, Optometrists
• Nancy Elsharkawy

• Optometrist in Monmouth, IL
• Providers in Monmouth, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.