Healthcare Provider Details

I. General information

NPI: 1750207080
Provider Name (Legal Business Name): OPALMEDICUS MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5811 FIRE OPAL WAY
INDIANAPOLIS IN
46239-1899
US

IV. Provider business mailing address

5811 FIRE OPAL WAY
INDIANAPOLIS IN
46239-1899
US

V. Phone/Fax

Practice location:
  • Phone: 818-278-1789
  • Fax:
Mailing address:
  • Phone: 818-278-1789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. MANISHREDDY VUNDYALA
Title or Position: MD
Credential: MD
Phone: 818-278-1789