Provider Demographics
NPI:1265545644
Name:BROGDEN, NEIL W (OD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:W
Last Name:BROGDEN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:186 AW DRIVE
Mailing Address - Street 2:
Mailing Address - City:STONEWALL
Mailing Address - State:LA
Mailing Address - Zip Code:71078
Mailing Address - Country:US
Mailing Address - Phone:318-780-6006
Mailing Address - Fax:
Practice Address - Street 1:VITREO-RETINAL ASSOCIATES
Practice Address - Street 2:836 OLIVE STREET
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-2102
Practice Address - Country:US
Practice Address - Phone:318-222-8421
Practice Address - Fax:318-673-9972
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1425-566T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist