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Organization
MARY L. DEMOSS O.D. INC.
Active
Organization
MARY L. DEMOSS O.D. INC.
Active
Other names
Canyon Lake Vision Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARY LUCINDA DEMOSS OD (OWNER)
(951) 244-4444
Entity
Organization
Contact information
Practice address
31722 RAILROAD CANYON RD, CANYON LAKE, CA 92587-9486
(951) 244-4444
(951) 244-1414
Mailing address
31722 RAILROAD CANYON RD, CANYON LAKE, CA 92587-9486
(951) 244-4444
(951) 244-1414
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
8955
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GSD004910
—
CA
Enumeration date
06/19/2006
Last updated
02/13/2008
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