Provider Demographics
NPI:1346621588
Name:STOUT, KENDALL DEAN (OD)
Entity Type:Individual
Prefix:
First Name:KENDALL
Middle Name:DEAN
Last Name:STOUT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8376 MOJAVE TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-3638
Mailing Address - Country:US
Mailing Address - Phone:682-628-2531
Mailing Address - Fax:682-499-9350
Practice Address - Street 1:8376 MOJAVE TRL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-3638
Practice Address - Country:US
Practice Address - Phone:682-628-2531
Practice Address - Fax:682-499-9350
Is Sole Proprietor?:No
Enumeration Date:2015-06-12
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8700TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist