Healthcare Provider Details

I. General information

NPI: 1881600708
Provider Name (Legal Business Name): RONNIE WAYNE BIAS C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 W COLLEGE ST
LAKE CHARLES LA
70605-1529
US

IV. Provider business mailing address

505 W COLLEGE ST
LAKE CHARLES LA
70605-1529
US

V. Phone/Fax

Practice location:
  • Phone: 337-474-2989
  • Fax: 337-474-2996
Mailing address:
  • Phone: 337-474-2989
  • Fax: 337-474-2996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO02273
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO02273
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: