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General NPI Number Information
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NPI Number | 1760706014
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Entity Type | Organization
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Legal Business Name | CELESTE ACOSTA, O.D., P.C.
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Dates
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Enumeration Date | 03/16/2010
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 11864 BANDERA RD
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City | HELOTES
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State | TX
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Zip | 78023-4132
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Country | US
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Telephone | 210-695-2222
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Fax | 210-695-2225
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Provider Business Mailing Address
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Address Line | 11864 BANDERA RD
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City | HELOTES
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State | TX
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Zip | 78023-4132
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Country | US
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Telephone | 210-695-2222
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Fax | 210-695-2225
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Authorized Official
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Title or Position | DIRECTOR
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Name | CELESTE ACOSTA WADE
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Credential | O.D.
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Telephone | 361-722-9218
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 5849TG
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License Number State | TX
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