Provider Demographics
NPI:1881368777
Name:KHALDIEH, SAMI
Entity type:Individual
Prefix:
First Name:SAMI
Middle Name:
Last Name:KHALDIEH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 JOHN MILTON DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20171-2527
Mailing Address - Country:US
Mailing Address - Phone:703-239-6633
Mailing Address - Fax:703-239-6634
Practice Address - Street 1:2539 JOHN MILTON DR
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-2527
Practice Address - Country:US
Practice Address - Phone:703-239-6633
Practice Address - Fax:703-239-6634
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003054152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist