Provider Demographics
NPI:1336144294
Name:STOUT, THOMAS A (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
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 1:3000 HAMPTON CTR
Mailing Address - Street 2:STE A
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-1708
Mailing Address - Country:US
Mailing Address - Phone:304-598-2020
Mailing Address - Fax:304-598-2024
Practice Address - Street 1:3000 HAMPTON CTR
Practice Address - Street 2:STE A
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1708
Practice Address - Country:US
Practice Address - Phone:304-598-2020
Practice Address - Fax:304-598-2024
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV 719 OD152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV244618OtherMAMSI
WV0150667000Medicaid
WV410000097OtherPALMETTO
WVT32570Medicare UPIN
WVTH9296471Medicare ID - Type Unspecified