Provider Demographics
NPI:1700972361
Name:BIO PROSTHETIC-ORTHOTIC LAB, INC.
Entity type:Organization
Organization Name:BIO PROSTHETIC-ORTHOTIC LAB, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-726-4092
Mailing Address - Street 1:21785 FILIGREE COURT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147
Mailing Address - Country:US
Mailing Address - Phone:703-726-4092
Mailing Address - Fax:703-726-4095
Practice Address - Street 1:21785 FILIGREE COURT
Practice Address - Street 2:SUITE 210
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147
Practice Address - Country:US
Practice Address - Phone:703-726-4092
Practice Address - Fax:703-726-4095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD255938200Medicaid
VA9190724Medicaid
DC031289800Medicaid