NPIMap

Organization Active NPI

Mary L. Demoss O.D. Inc.

Doing business as Canyon Lake Vision Center

  • Optometrist
  • Canyon Lake, CA
National Provider Identifier
1457396871
Registry record updated Feb 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
8955 Issued in CA
Legal business name
MARY L. DEMOSS O.D. INC.
Doing business as
Canyon Lake Vision Center
Practice address
31722 Railroad Canyon Rd
Canyon Lake, CA 92587-9486
Phone
(951) 244-4444
Fax
(951) 244-1414
NPI assigned
Jun 19, 2006
Last updated
Feb 13, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mary Lucinda Demoss, ODNPI 1912958539
Title
Owner
Phone
(951) 244-4444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 8955 CA Primary

Addresses

Primary practice location

31722 Railroad Canyon Rd
Canyon Lake, CA 92587-9486

Mailing address

31722 Railroad Canyon Rd
Canyon Lake, CA 92587-9486
Phone (951) 244-4444

Other identifiers 1

IdentifierTypeStateIssuer
GSD004910MedicaidCA

Other names 1

  • Canyon Lake Vision Center Doing business as

National Provider Directory

National Provider Directory

Locations

31722 Railroad Canyon Rd
Canyon Lake, CA 92587
Phone (951) 244-4444

31740 Railroad Canyon Rd
Ste 4
Canyon Lake, CA 92587
Phone (951) 244-4444

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202860800000",
    "number": "1457396871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31722 RAILROAD CANYON RD",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925879486",
            "telephone_number": "951-244-4444",
            "fax_number": "951-244-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31722 RAILROAD CANYON RD",
            "city": "CANYON LAKE",
            "state": "CA",
            "postal_code": "925879486",
            "telephone_number": "951-244-4444",
            "fax_number": "951-244-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY L. DEMOSS O.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2008-02-13",
        "status": "A",
        "authorized_official_last_name": "DEMOSS",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "LUCINDA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "951-244-4444",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8955",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD004910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Canyon Lake Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Canyon Lake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.