Provider Demographics
NPI:1306675673
Name:JONAS, MARISA SUE (OD)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:SUE
Last Name:JONAS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:HOISINGTON
Mailing Address - State:KS
Mailing Address - Zip Code:67544-1847
Mailing Address - Country:US
Mailing Address - Phone:620-653-2749
Mailing Address - Fax:620-653-4508
Practice Address - Street 1:801 N PINE ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1847
Practice Address - Country:US
Practice Address - Phone:620-653-2749
Practice Address - Fax:620-653-4508
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist