Provider Demographics
NPI:1326190091
Name:HOMESTEAD, ALAN H (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:H
Last Name:HOMESTEAD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10252 16TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-1432
Mailing Address - Country:US
Mailing Address - Phone:206-767-4737
Mailing Address - Fax:
Practice Address - Street 1:10252 16TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-1432
Practice Address - Country:US
Practice Address - Phone:206-767-4737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1428 TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030484Medicaid
WAGOOO 102327Medicare ID - Type UnspecifiedPROVIDER #
WATO1629Medicare UPIN