MEDICARE: VISIONARY ENTERPRISES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000695887	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1720284748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONARY ENTERPRISES INC

Provider Business Mailing Address
First Line	:	6626 E 75TH ST STE 200
Second Line	:	ATTN L PENDLETON
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2855
Country	:	US
Telephone Number	:	317-621-7543
Fax Number	:	317-621-7163

Provider Business Practice Location Address
First Line	:	7120 CLEARVISTA DR STE 1000
Second Line	:	ATTN: FIGLEAF BOUTIQUE
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46256-1672
Country	:	US
Telephone Number	:	317-621-5323
Fax Number	:	317-621-3447

Authorized Official
Title or Position	:	SVP
Name	:	MR. MIKE HOGAN
Credential	:
Telephone Number	:	317-621-7409

Provider Enumeration Date	:	06/26/2007
Last Update Date	:	07/30/2019

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Directions to “VISIONARY ENTERPRISES INC ” Practice Location

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