Provider Demographics
NPI:1114920741
Name:MOESSINGER, JOHN CHARLES III (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHARLES
Last Name:MOESSINGER
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOHN
Other - Middle Name:C
Other - Last Name:MOESSINGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1414 S MILLER ST
Mailing Address - Street 2:STE 8
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-6961
Mailing Address - Country:US
Mailing Address - Phone:805-928-5959
Mailing Address - Fax:805-925-5313
Practice Address - Street 1:1414 S MILLER ST
Practice Address - Street 2:STE 8
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-6961
Practice Address - Country:US
Practice Address - Phone:805-928-5959
Practice Address - Fax:805-925-5313
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6749T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70136Medicare UPIN
CA3042714Medicare UPIN