Provider Demographics
NPI:1720655020
Name:BIO ORTHOPEDIC LAB, LLC
Entity type:Organization
Organization Name:BIO ORTHOPEDIC LAB, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:KAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-944-6243
Mailing Address - Street 1:1530 E EDINGER AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-4915
Mailing Address - Country:US
Mailing Address - Phone:877-944-6243
Mailing Address - Fax:714-587-3230
Practice Address - Street 1:1530 E EDINGER AVE STE 5
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-4915
Practice Address - Country:US
Practice Address - Phone:877-944-6243
Practice Address - Fax:714-587-3230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier