Provider Demographics
NPI:1235198714
Name:STOUT, RICHARD R (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:R
Last Name:STOUT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 MASON ST
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1104
Mailing Address - Country:US
Mailing Address - Phone:315-789-3937
Mailing Address - Fax:315-789-2616
Practice Address - Street 1:70 MASON ST
Practice Address - Street 2:
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1104
Practice Address - Country:US
Practice Address - Phone:315-789-3937
Practice Address - Fax:315-789-2616
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-22
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY225735207W00000X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
201178047OtherGROUP HEALTH INCORPORATED
4086529OtherAETNA
7700447OtherMVP SELECT CARE
P010225735OtherEXCELLUS BCBS
P010225735OtherMONROE PLAN
201178047OtherUNITED HEALTH CARE EMPIRE
201178047OtherSIDNEY HILLMAN
201178047OtherWORKERS COMPENSATION
201178047OtherPOMCO
201178047OtherTRICARE
82636OtherFIRST HEALTH
141751CROtherPREFERRED CARE OPTION
P00141516OtherRAILROAD MEDICARE
141751CROtherPREFERRED CARE
201178047OtherUNITED HEALTH CARE
7702618OtherDOCTORS HEALTH PLAN
P010225735OtherHEALTHY NY
7700447OtherMVP SELECT CARE
4086529OtherAETNA
NYRA2836Medicare PIN