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NPI Code Detail

MEDICARE: DR. JESSICA CELESTINO O.D.

MEDICARE: DR. JESSICA CELESTINO O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist1091NV

General Provider Information

NPI Number : 1710591110
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JESSICA CELESTINO O.D.
Provider Business Mailing Address
First Line : 2021 N RAINBOW BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-7098
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2021 N RAINBOW BLVD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89108-7098
Country : US
Telephone Number : 702-529-3145
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/02/2020
Last Update Date : 02/22/2021

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