Provider Demographics
NPI:1417915729
Name:BURI, MARKUS (OD)
Entity Type:Individual
Prefix:DR
First Name:MARKUS
Middle Name:
Last Name:BURI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:731 E FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4337
Mailing Address - Country:US
Mailing Address - Phone:951-766-8587
Mailing Address - Fax:
Practice Address - Street 1:731 E FLORIDA AVE
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4337
Practice Address - Country:US
Practice Address - Phone:951-766-8587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA8430TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410010767OtherRAILROAD MEDICARE
CASD0084300Medicaid
410010767OtherRAILROAD MEDICARE
CASD0084301Medicare PIN
CASD0084300Medicare PIN
CAT10690Medicare UPIN