Healthcare Provider Details

I. General information

NPI: 1568797645
Provider Name (Legal Business Name): DANIEL JOSEPH BRAUNER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2009
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: 208-677-5465
  • Fax: 208-677-5467
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 Number6871867
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60509231
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: