Provider Demographics
NPI:1891723888
Name:SALIBA, KARL CONSTANTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:CONSTANTIN
Last Name:SALIBA
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 1:2222 ELECTRIC RD, SW
Mailing Address - Street 2:PO BOX 20108
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0011
Mailing Address - Country:US
Mailing Address - Phone:540-774-8007
Mailing Address - Fax:540-774-4530
Practice Address - Street 1:2222 ELECTRIC RD, SW
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
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9205047Medicaid
VA004183OtherANTHEM BLUE CROSS/BLUE SH
VA9205047Medicaid
VA580000057Medicare PIN
VA410004190Medicare PIN
VA004183OtherANTHEM BLUE CROSS/BLUE SH