Healthcare Provider Details

I. General information

NPI: 1275671778
Provider Name (Legal Business Name): RICHARD R STOUT MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 MASON ST
GENEVA NY
14456-1104
US

IV. Provider business mailing address

70 MASON ST
GENEVA NY
14456-1104
US

V. Phone/Fax

Practice location:
  • Phone: 315-789-3937
  • Fax: 315-789-2616
Mailing address:
  • Phone: 315-789-3937
  • Fax: 315-789-2616

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number225735
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number225735
License Number StateNY

VIII. Authorized Official

Name: DR. RICHARD R STOUT
Title or Position: PRESIDENT
Credential: MD
Phone: 315-789-3937