Provider Demographics
NPI:1821195801
Name:CARL D. OUTEN, MD, PC
Entity Type:Organization
Organization Name:CARL D. OUTEN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARL
Authorized Official - Middle Name:D
Authorized Official - Last Name:OUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PC
Authorized Official - Phone:804-794-1334
Mailing Address - Street 1:605 N COURTHOUSE RD
Mailing Address - Street 2:STE 101
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23236-4068
Mailing Address - Country:US
Mailing Address - Phone:804-794-1334
Mailing Address - Fax:804-794-3927
Practice Address - Street 1:605 N COURTHOUSE RD
Practice Address - Street 2:STE 101
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23236-4068
Practice Address - Country:US
Practice Address - Phone:804-794-1334
Practice Address - Fax:804-794-3927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101031359207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006359523Medicaid
VA1800000037Medicare ID - Type UnspecifiedPROVIDER NO