Healthcare Provider Details

I. General information

NPI: 1528612140
Provider Name (Legal Business Name): TRINITY VISION CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 05/25/2026
Certification Date: 05/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 N OVERLAND AVE
BURLEY ID
83318-3432
US

IV. Provider business mailing address

385 N OVERLAND AVE
BURLEY ID
83318-3432
US

V. Phone/Fax

Practice location:
  • Phone: 208-667-5465
  • Fax: 208-667-5467
Mailing address:
  • Phone: 208-667-5465
  • Fax: 208-667-5467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DANIEL BRAUNER
Title or Position: OWNER
Credential:
Phone: 208-667-5465