Provider Demographics
NPI:1306816343
Name:STOUT, ANTHONY PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:PAUL
Last Name:STOUT
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:801 VASSAR DR NE
Mailing Address - Street 2:OPTOMETRY CLINIC
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-2725
Mailing Address - Country:US
Mailing Address - Phone:505-508-8553
Mailing Address - Fax:505-248-7721
Practice Address - Street 1:ALBUQUERQUE INDIAN HEALTH CENTER- OPTOMETRY CLINIC
Practice Address - Street 2:801 VASSAR DR. N.E.
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-248-4037
Practice Address - Fax:505-248-7721
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2015-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
UT5670092-9934152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMV02659Medicare UPIN