Provider Demographics
NPI:1649278839
Name:GREIDINGER, LARRY J (OD)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:J
Last Name:GREIDINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 PRINCESS RD
Mailing Address - Street 2:STE 202
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2322
Mailing Address - Country:US
Mailing Address - Phone:609-219-9000
Mailing Address - Fax:609-219-1313
Practice Address - Street 1:4 PRINCESS RD
Practice Address - Street 2:STE 202
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648-2322
Practice Address - Country:US
Practice Address - Phone:609-219-9000
Practice Address - Fax:609-219-1313
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00396800152W00000X
NJ27TO00049400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0116010OtherAETNA
NJ0760404Medicaid
NJ222516468OtherHORIZON
NJ222516468OtherHORIZON
U23830Medicare UPIN