Provider Demographics
NPI:1477048585
Name:GHANCHI, SALMAN AHMED (OD)
Entity Type:Individual
Prefix:
First Name:SALMAN
Middle Name:AHMED
Last Name:GHANCHI
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:44 E BROAD ST STE 105
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-5946
Practice Address - Country:US
Practice Address - Phone:610-867-0588
Practice Address - Fax:610-867-1057
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9539T152W00000X
PAOEG003853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist