Provider Demographics
NPI:1811007156
Name:VITAL OPTION MEDICAL SUPPLY CORP.
Entity Type:Organization
Organization Name:VITAL OPTION MEDICAL SUPPLY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:BADLISSI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-290-2268
Mailing Address - Street 1:6595 NW 36TH ST
Mailing Address - Street 2:SUITE 300B
Mailing Address - City:VIRGINIA GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6979
Mailing Address - Country:US
Mailing Address - Phone:786-290-2268
Mailing Address - Fax:
Practice Address - Street 1:6595 NW 36TH ST
Practice Address - Street 2:SUITE 300B
Practice Address - City:VIRGINIA GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33166-6979
Practice Address - Country:US
Practice Address - Phone:786-290-2268
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5786540001Medicare NSC