Provider Demographics
NPI:1568797645
Name:BRAUNER, DANIEL JOSEPH (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:BRAUNER
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 1:110 S 72ND AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908-4600
Mailing Address - Country:US
Mailing Address - Phone:509-576-4292
Mailing Address - Fax:
Practice Address - Street 1:110 S 72ND AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908-4600
Practice Address - Country:US
Practice Address - Phone:509-576-4292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-07
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60509231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2050289Medicaid
WAG8937644Medicare PIN