Provider Demographics
NPI:1619190709
Name:STOUT, DAVID EDWARD (OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:EDWARD
Last Name:STOUT
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12614 KARI ANNE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-1763
Mailing Address - Country:US
Mailing Address - Phone:915-852-2861
Mailing Address - Fax:
Practice Address - Street 1:121 N KENAZO AVE
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-5407
Practice Address - Country:US
Practice Address - Phone:915-852-2861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician