Provider Demographics
NPI:1164566147
Name:ALIBHAI, SULEIMAN S (OD)
Entity Type:Individual
Prefix:
First Name:SULEIMAN
Middle Name:S
Last Name:ALIBHAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2227 WOODFORD RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5084
Mailing Address - Country:US
Mailing Address - Phone:703-855-5218
Mailing Address - Fax:
Practice Address - Street 1:2227 WOODFORD RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5084
Practice Address - Country:US
Practice Address - Phone:703-855-5218
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000774152WL0500X
MDTA1159152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009236317Medicaid
01659I00OtherINOVA MEDICARE
VA11125626OtherCAQH PROVIDER ID
176568R87Medicare ID - Type Unspecified
VA009236317Medicaid