Provider Demographics
NPI:1073888244
Name:GRIFFETH, KARLI SPETZLER
Entity Type:Individual
Prefix:
First Name:KARLI
Middle Name:SPETZLER
Last Name:GRIFFETH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KARLI
Other - Middle Name:
Other - Last Name:SPETZLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1789
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24008-1789
Mailing Address - Country:US
Mailing Address - Phone:540-855-3554
Mailing Address - Fax:
Practice Address - Street 1:707 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5100
Practice Address - Country:US
Practice Address - Phone:540-855-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260047207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVL216AMedicare PIN