Distin, Gary D
Distin, Gary D is an individual health care provider with primary practice located at 67 Public Sq , Monmouth IL 61462-1755. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Distin, Gary D can be contacted via phone (309) 734-3108.Contact Information
Primary practice address
67 Public Sq
Monmouth IL 61462-1755
Phone: (309) 734-3108
Fax: (309) 734-6988
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 046006527 | Illinois |
Profile Details
| NPI number | 1477548287 |
|---|---|
| LBN Legal business name | Distin, Gary D |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 19th, 2005 |
| Last updated | May 25th, 2010 - about 14 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1477548287 | NPPES |
| Illinois | MEDICAID | 046006527 |
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