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General NPI Number Information
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NPI Number | 1265545644
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Entity Type | Individual
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Provider Name | NEIL W BROGDEN OD
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 02/07/2023
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Provider Practice Location Address
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Address Line | VITREO-RETINAL ASSOCIATES 836 OLIVE STREET
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City | SHREVEPORT
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State | LA
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Zip | 71104-2102
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Country | US
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Telephone | 318-222-8421
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Fax | 318-673-9972
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Provider Business Mailing Address
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Address Line | 186 AW DRIVE
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City | STONEWALL
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State | LA
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Zip | 71078
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Country | US
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Telephone | 318-780-6006
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1425-566T
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License Number State | LA
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