Provider Demographics
NPI:1528085248
Name:SEADLER, CELESTE (OD)
Entity type:Individual
Prefix:DR
First Name:CELESTE
Middle Name:
Last Name:SEADLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 S WALTERS AVE
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1533
Mailing Address - Country:US
Mailing Address - Phone:270-358-8141
Mailing Address - Fax:
Practice Address - Street 1:109 S WALTERS AVE
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1533
Practice Address - Country:US
Practice Address - Phone:270-358-8141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1639DT152W00000X
IN18003362A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY5419240003OtherMEDICARE NSC - DMERC
KY5419240012OtherMEDICARE NSC - DMERC
KY77001394Medicaid
KYP00609334OtherRR MEDICARE
KY000000533153OtherANTHEM BCBS
KY000000532002OtherANTHEM BCBS
KY5419240003OtherMEDICARE NSC - DMERC
V05964Medicare UPIN