Provider Demographics
NPI:1164674289
Name:KARL C. SALIBA, O.D., PC
Entity Type:Organization
Organization Name:KARL C. SALIBA, O.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARL
Authorized Official - Middle Name:C
Authorized Official - Last Name:SALIBA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:540-774-8007
Mailing Address - Street 1:2222 ELECTRIC ROAD, S.W.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-2300
Mailing Address - Country:US
Mailing Address - Phone:540-774-8007
Mailing Address - Fax:540-774-4530
Practice Address - Street 1:2222 ELECTRIC ROAD, S.W.
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-2300
Practice Address - Country:US
Practice Address - Phone:540-774-8007
Practice Address - Fax:540-774-4530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9205047Medicaid
VA9205047Medicaid
VA6213570002Medicare NSC
VADP2150Medicare PIN