Provider Demographics
NPI:1689787186
Name:STOUT, RONALD CRAIG (OD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:CRAIG
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 1:2067 WEST VISTA WAY
Mailing Address - Street 2:STE 120
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6031
Mailing Address - Country:US
Mailing Address - Phone:760-758-2020
Mailing Address - Fax:760-758-1410
Practice Address - Street 1:2067 WEST VISTA WAY
Practice Address - Street 2:STE 120
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6031
Practice Address - Country:US
Practice Address - Phone:760-758-2020
Practice Address - Fax:760-758-1410
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5783T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWOP5783FMedicare ID - Type Unspecified
U38517Medicare UPIN