Healthcare Provider Details

I. General information

NPI: 1306675673
Provider Name (Legal Business Name): MARISA SUE BURGER OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIS S JONAS OD

II. Dates (important events)

Enumeration Date: 07/26/2024
Last Update Date: 10/27/2025
Certification Date: 10/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 N PINE ST
HOISINGTON KS
67544-1847
US

IV. Provider business mailing address

801 N PINE ST
HOISINGTON KS
67544-1847
US

V. Phone/Fax

Practice location:
  • Phone: 620-653-2749
  • Fax: 620-653-4508
Mailing address:
  • Phone: 620-653-2749
  • Fax: 620-653-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2219
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: