Healthcare Provider Details

I. General information

NPI: 1992753545
Provider Name (Legal Business Name): ERIC DAMIAN GRIENER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 04/27/2020
Certification Date: 04/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17170 S I 12 SERVICE RD
HAMMOND LA
70403-2408
US

IV. Provider business mailing address

2831 MONROE ST
MANDEVILLE LA
70448-4936
US

V. Phone/Fax

Practice location:
  • Phone: 985-375-1111
  • Fax: 985-542-0733
Mailing address:
  • Phone: 985-375-1111
  • Fax: 985-542-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number019548
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number019548
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD.019548
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: