Provider Demographics
NPI:1912624651
Name:LAKE AREA PROSTHETICS & ORTHOTICS, L.L.C.
Entity Type:Organization
Organization Name:LAKE AREA PROSTHETICS & ORTHOTICS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:BIAS
Authorized Official - Suffix:
Authorized Official - Credentials:CERTIFIED CPO, CPED
Authorized Official - Phone:337-474-2989
Mailing Address - Street 1:PO BOX 4571
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-4571
Mailing Address - Country:US
Mailing Address - Phone:337-474-2989
Mailing Address - Fax:337-474-2996
Practice Address - Street 1:433 S UNION ST
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-6119
Practice Address - Country:US
Practice Address - Phone:337-474-2989
Practice Address - Fax:337-474-2996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-24
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier