# BRYAN VEKOVIUS M.D. LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700085727
- **Authorized official:** BRYAN JOHANNES VEKOVIUS M.D. (DOCTOR)
- **Authorized official phone:** (318) 675-3733

## Contact information

- **Practice address:** 450 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106
- **Practice address phone:** (318) 675-3733
- **Practice address fax:** (318) 675-3734
- **Mailing address:** 450 ASHLEY RIDGE BLVD, SHREVEPORT, LA 71106-7228
- **Mailing address phone:** (318) 675-3733
- **Mailing address fax:** (318) 675-3734

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | LO 23263 | LA | Yes |

## Other

- **Enumeration date:** 07/11/2007
- **Last updated:** 08/31/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1285674820 | INDIVIDAL NPI\# | LA |