Provider Demographics
NPI:1285019893
Name:STOUT, NICOLE CATHERINE (OD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:CATHERINE
Last Name:STOUT
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 N GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-7017
Mailing Address - Country:US
Mailing Address - Phone:918-444-4000
Mailing Address - Fax:
Practice Address - Street 1:4000 E US HIGHWAY 377
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76049-7432
Practice Address - Country:US
Practice Address - Phone:817-573-7153
Practice Address - Fax:817-573-5640
Is Sole Proprietor?:No
Enumeration Date:2015-07-24
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10415TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist