Provider Demographics
NPI:1396793485
Name:ACOSTA, CELESTE (OD)
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:
Last Name:ACOSTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CELESTE
Other - Middle Name:A
Other - Last Name:WADE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11864 BANDERA RD
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4132
Mailing Address - Country:US
Mailing Address - Phone:210-695-2222
Mailing Address - Fax:210-695-2225
Practice Address - Street 1:11864 BANDERA RD
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4132
Practice Address - Country:US
Practice Address - Phone:210-695-2222
Practice Address - Fax:210-695-2225
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5849TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB101430Medicare PIN
TXU86677Medicare UPIN