Provider Demographics
NPI:1083707590
Name:STOUT, STEVE ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVE
Middle Name:ALAN
Last Name:STOUT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 COUNTRYSIDE DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-3663
Mailing Address - Country:US
Mailing Address - Phone:970-203-4119
Mailing Address - Fax:
Practice Address - Street 1:1250 E MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-2702
Practice Address - Country:US
Practice Address - Phone:970-224-0606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3663152W00000X
IN18001972A AND B152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU12016Medicare UPIN
IN442900Medicare PIN