Provider Demographics
NPI:1649218355
Name:HOMERSTAD WILLIAMS, CAIA DAWN (OD)
Entity Type:Individual
Prefix:
First Name:CAIA
Middle Name:DAWN
Last Name:HOMERSTAD WILLIAMS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CAIA
Other - Middle Name:DAWN
Other - Last Name:HOMERSTAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:107 JAMES COLEMAN DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-3100
Mailing Address - Country:US
Mailing Address - Phone:361-578-0234
Mailing Address - Fax:361-578-3812
Practice Address - Street 1:107 JAMES COLEMAN DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-3100
Practice Address - Country:US
Practice Address - Phone:361-578-0234
Practice Address - Fax:361-578-3812
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5250TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87X004Medicare PIN
TXU62284Medicare UPIN