Provider Demographics
NPI:1043383961
Name:NORTHSHORE EYE ASSOCIATES LLC
Entity Type:Organization
Organization Name:NORTHSHORE EYE ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:GRIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-375-1111
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1944297Medicaid