Distler, Huntington & Blair PSC

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

35792 Issued in KY

Legal business name

DISTLER, HUNTINGTON & BLAIR PSC

Doing business as

Bluegrass Eye Center

Practice address

4402 Churchman Ave
Ste 306
Louisville, KY 40215-3101

Phone

(502) 367-6137

Fax

(502) 367-4020

NPI assigned

Mar 31, 2016

Organization subpart

No

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

Authorized official

Name

Jennifer Butts

Title

Billing Manager

Phone

(502) 243-2280

Specialties & licenses 3

Addresses

Other identifiers 1

Other names 1

• Bluegrass Eye Center Doing business as

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

{
    "created_epoch": "1459382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459382400000",
    "number": "1780047456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6400 WESTWIND WAY",
            "city": "CRESTWOOD",
            "state": "KY",
            "postal_code": "400146773",
            "telephone_number": "502-243-2227",
            "fax_number": "502-243-2237"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4402 CHURCHMAN AVE",
            "address_2": "STE 306",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402153101",
            "telephone_number": "502-367-6137",
            "fax_number": "502-367-4020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DISTLER, HUNTINGTON & BLAIR PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-31",
        "last_updated": "2016-03-31",
        "status": "A",
        "authorized_official_last_name": "BUTTS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "502-243-2280"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "KY",
            "license": "1994DT",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "35792",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Ophthalmology",
            "state": "KY",
            "license": "24245",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65917833",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bluegrass Eye Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Derek Disponette
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• Christopher Distler, DPT
• Dana J Distler, M.D.
• Mark W Distler, M.D.
• Walter David Distler, DMD
• Kathleen Ann Dively, ARNP
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• Ophthalmology Physician in Louisville, KY
• Providers in Louisville, KY by specialty
• Ophthalmology Physician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; 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.