Provider Demographics
NPI:1336200179
Name:RONALD B. WILSON & LARRY J. GREIDINGER PTRS
Entity type:Organization
Organization Name:RONALD B. WILSON & LARRY J. GREIDINGER PTRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GREIDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:609-219-9000
Mailing Address - Street 1:4 PRINCESS RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2322
Mailing Address - Country:US
Mailing Address - Phone:609-219-9000
Mailing Address - Fax:609-219-1313
Practice Address - Street 1:4 PRINCESS RD
Practice Address - Street 2:SUITE 202
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2322
Practice Address - Country:US
Practice Address - Phone:609-219-9000
Practice Address - Fax:609-219-1313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0116010OtherAETNA
03677960000OtherAMERIHEALTH
0997381005OtherCIGNA - WILSON
3K3739OtherHEALTHNET
1427055516OtherWILSON INDIVIDUAL NPI #
1649278839OtherGREIDINGER - INDIVID. NPI
MS341OtherOXFORD - GREIDINGER
0620326066OtherCIGNA - GREIDINGER
MS340OtherOXFORD - WILSON
MS341OtherOXFORD - GREIDINGER
1649278839OtherGREIDINGER - INDIVID. NPI
3K3739OtherHEALTHNET
MS340OtherOXFORD - WILSON
=========OtherUNITED HEALTHCARE