Provider Demographics
NPI:1992753545
Name:GRIENER, ERIC DAMIAN (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAMIAN
Last Name:GRIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70448-4936
Mailing Address - Country:US
Mailing Address - Phone:985-375-1111
Mailing Address - Fax:985-542-0733
Practice Address - Street 1:17170 S I 12 SERVICE RD
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-2408
Practice Address - Country:US
Practice Address - Phone:985-375-1111
Practice Address - Fax:985-542-0733
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019548174400000X, 207WX0110X
LAMD.019548207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1900745Medicaid
LA1944297Medicaid
LA5C820Medicare ID - Type Unspecified
LA1944297Medicaid