Individual
DR. BENJAMIN STOUT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
3930 CEDAR GROVE PKWY, EAGAN, MN 55122-1403
(651) 454-5661
(651) 454-5669
Mailing address
3930 CEDAR GROVE PKWY, EAGAN, MN 55122-1403
(651) 454-5661
(651) 454-5669
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2764
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004695700
—
MN
Enumeration date
06/21/2005
Last updated
05/19/2011
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