Healthcare Provider Details

I. General information

NPI: 1790869253
Provider Name (Legal Business Name): LA OPTICAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N CAUSEWAY BLVD SUITE 2
MANDEVILLE LA
70471-3243
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 985-375-1109
  • Fax: 985-727-0178
Mailing address:
  • Phone: 985-375-1101
  • Fax: 985-542-0733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number88040235
License Number StateLA

VIII. Authorized Official

Name: DR. ERIC DAMIAN GRIENER
Title or Position: OWNER
Credential: M.D.
Phone: 985-542-3336