MEDICARE: ALAN H. HOMESTEAD OD PS

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
1	152W00000X	Optometrist	1428	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124143847
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALAN H. HOMESTEAD OD PS

Provider Business Mailing Address
First Line	:	10252 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-1432
Country	:	US
Telephone Number	:	206-767-4737
Fax Number	:

Provider Business Practice Location Address
First Line	:	10252 16TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98146-1432
Country	:	US
Telephone Number	:	206-767-4737
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ALAN H HOMESTEAD
Credential	:
Telephone Number	:	206-767-4737

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	10/02/2007

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