Provider Demographics
NPI:1386614659
Name:GRIENEISEN, ANTHONY J (OD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:J
Last Name:GRIENEISEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-4432
Mailing Address - Country:US
Mailing Address - Phone:717-249-4948
Mailing Address - Fax:717-249-0558
Practice Address - Street 1:25 STATE AVE
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-4432
Practice Address - Country:US
Practice Address - Phone:717-249-4948
Practice Address - Fax:717-249-0558
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000411152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30003Medicare UPIN
PA184932Medicare ID - Type Unspecified