Provider Demographics
NPI:1245373406
Name:PINKHAM, CELESTE LIEN (OD)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:LIEN
Last Name:PINKHAM
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 1:601 E WHITTIER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-3972
Mailing Address - Country:US
Mailing Address - Phone:562-697-6733
Mailing Address - Fax:
Practice Address - Street 1:601 E WHITTIER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-3972
Practice Address - Country:US
Practice Address - Phone:562-697-6733
Practice Address - Fax:562-697-8303
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11205TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASC0112050Medicaid
CAU77423Medicare UPIN