MEDICARE: DR. MARY LUCINDA DEMOSS OD

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	8955	CA

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	:	1912958539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY LUCINDA DEMOSS OD

Provider Business Mailing Address
First Line	:	23002 LAKE CENTER DR
Second Line	:
City	:	LAKE FOREST
State	:	CA
Zip	:	92630-6801
Country	:	US
Telephone Number	:	949-454-1064
Fax Number	:	949-454-4111

Provider Business Practice Location Address
First Line	:	31722 RAILROAD CANYON RD
Second Line	:
City	:	CANYON LAKE
State	:	CA
Zip	:	92587-9486
Country	:	US
Telephone Number	:	951-244-4444
Fax Number	:	951-244-1414

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	11/04/2016

Similar Medicare Providers

1457396871 — MARY L. DEMOSS O.D. INC.
Practice Location Address:

31722 RAILROAD CANYON RD
CANYON LAKE, CA
92587-9486

Practice Phone: 951-244-4444
Practice Fax: 951-244-1414

1093844342 — DR. STEVEN D HOLMSTROM O.D.
Practice Location Address:

31722 RAILROAD CANYON RD
CANYON LAKE, CA
92587-9486

Practice Phone: 951-244-4444
Practice Fax:

1962673186 — STEVEN D. HOLMSTROM, O.D.
Practice Location Address:

31722 RAILROAD CANYON RD
CANYON LAKE, CA
92587-9486

Practice Phone: 951-244-4444
Practice Fax: 951-244-1414

1164660072 — STEVEN D HOLMSTROM O D INC
Practice Location Address:

31722 RAILROAD CANYON RD
CANYON LAKE, CA
92587-9486

Practice Phone: 951-244-4444
Practice Fax:

1740980655 — JUSTICE IVY HAGG
Practice Location Address:

1070 WILSON RDG
LAKE CORMORANT, MS
38641-9486

Practice Phone: 901-463-8873
Practice Fax:

1821778598 — STELLA O EJIOGU
Practice Location Address:

2249 LAKE HERITAGE DR
TALLAHASSEE, FL
32311-9486

Practice Phone: 850-345-7607
Practice Fax:

Directions to “ DR. MARY LUCINDA DEMOSS OD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.