Provider Demographics
NPI:1235210147
Name:RICHARD L. STOUT, O.D.P.C.
Entity Type:Organization
Organization Name:RICHARD L. STOUT, O.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:L
Authorized Official - Last Name:STOUT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:765-362-8606
Mailing Address - Street 1:502 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1812
Mailing Address - Country:US
Mailing Address - Phone:765-362-8606
Mailing Address - Fax:765-362-8779
Practice Address - Street 1:502 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1812
Practice Address - Country:US
Practice Address - Phone:765-362-8606
Practice Address - Fax:765-362-8779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001770A152W00000X
IN18002826A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN556910Medicare ID - Type Unspecified
IN0388410001Medicare NSC