Provider Demographics
NPI:1275767147
Name:ORTHOTICS & PROSTHETICS LABORATORIES, INC.
Entity Type:Organization
Organization Name:ORTHOTICS & PROSTHETICS LABORATORIES, INC.
Other - Org Name:O & P LABS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:CO
Authorized Official - Phone:413-737-2404
Mailing Address - Street 1:300 BIRNIE AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01107-1107
Mailing Address - Country:US
Mailing Address - Phone:413-737-2404
Mailing Address - Fax:413-733-1389
Practice Address - Street 1:3500 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01107-1148
Practice Address - Country:US
Practice Address - Phone:413-737-2404
Practice Address - Fax:413-733-1389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO004133335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
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S009509OtherTRICARE
MA000000006888OtherBMC
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734427OtherCONNECTICARE
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MA360154OtherBCBS
65955037OtherVA
803119OtherTUFTS
15121OtherHNE
MA1540408Medicaid