Provider Demographics
NPI:1306269014
Name:CAIA D. HOMERSTAD OD PLLC
Entity type:Organization
Organization Name:CAIA D. HOMERSTAD OD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAIA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HOMERSTAD WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-212-4308
Mailing Address - Street 1:106 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1854
Mailing Address - Country:US
Mailing Address - Phone:361-582-0283
Mailing Address - Fax:361-576-0806
Practice Address - Street 1:7508 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2654
Practice Address - Country:US
Practice Address - Phone:361-212-4308
Practice Address - Fax:361-576-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5250TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E90VMedicare PIN