MEDICARE: CARL D OUTEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	0101031359	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114024189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARL D OUTEN M.D.

Provider Business Mailing Address
First Line	:	605 N COURTHOUSE RD
Second Line	:	STE 101
City	:	RICHMOND
State	:	VA
Zip	:	23236-4068
Country	:	US
Telephone Number	:	804-794-1334
Fax Number	:	804-794-3927

Provider Business Practice Location Address
First Line	:	605 N COURTHOUSE RD
Second Line	:	STE 101
City	:	RICHMOND
State	:	VA
Zip	:	23236-4068
Country	:	US
Telephone Number	:	804-794-1334
Fax Number	:	804-794-3927

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/23/2014

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Directions to “ CARL D OUTEN M.D.” Practice Location

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