Provider Demographics
NPI:1760706014
Name:CELESTE ACOSTA, O.D., P.C.
Entity Type:Organization
Organization Name:CELESTE ACOSTA, O.D., P.C.
Other - Org Name:THE EYE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CELESTE
Authorized Official - Middle Name:ACOSTA
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-722-9218
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-16
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5849TG332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB101429Medicare PIN