MEDICARE: SAMI KHALDIEH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	0618003054	VA

General Provider Information

NPI Number	:	1881368777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMI KHALDIEH

Provider Business Mailing Address
First Line	:	2539 JOHN MILTON DR
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-2527
Country	:	US
Telephone Number	:	703-239-6633
Fax Number	:	703-239-6634

Provider Business Practice Location Address
First Line	:	2539 JOHN MILTON DR
Second Line	:
City	:	HERNDON
State	:	VA
Zip	:	20171-2527
Country	:	US
Telephone Number	:	703-239-6633
Fax Number	:	703-239-6634

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	11/09/2025

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Directions to “ SAMI KHALDIEH ” Practice Location

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