Provider Demographics
NPI:1790869253
Name:LA OPTICAL, LLC
Entity Type:Organization
Organization Name:LA OPTICAL, 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:DAMIAN
Authorized Official - Last Name:GRIENER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-542-3336
Mailing Address - Street 1:17170 S I 12 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-2408
Mailing Address - Country:US
Mailing Address - Phone:985-375-1101
Mailing Address - Fax:985-542-0733
Practice Address - Street 1:1011 N CAUSEWAY BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-3243
Practice Address - Country:US
Practice Address - Phone:985-375-1109
Practice Address - Fax:985-727-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA88040235332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA88040235OtherSTATE LICENSE
LA88040235OtherSTATE LICENSE