Stout, Benjamin
Stout, Benjamin is an individual health care provider with primary practice located at 3930 Cedar Grove Pkwy , Eagan MN 55122-1403. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Stout, Benjamin can be contacted via phone (651) 454-5661.Contact Information
Primary practice address
3930 Cedar Grove Pkwy
Eagan MN 55122-1403
Phone: (651) 454-5661
Fax: (651) 454-5669
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 2764 | Minnesota |
Profile Details
| NPI number | 1265437792 |
|---|---|
| LBN Legal business name | Stout, Benjamin |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 21st, 2005 |
| Last updated | May 19th, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265437792 | NPPES |
| Minnesota | MEDICAID | 004695700 |
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