Provider Demographics
NPI:1528612140
Name:TRINITY VISION CENTER PLLC
Entity type:Organization
Organization Name:TRINITY VISION CENTER PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAUNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-266-0696
Mailing Address - Street 1:2200 MELROSE ST STE 7A
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-1579
Mailing Address - Country:US
Mailing Address - Phone:509-266-0696
Mailing Address - Fax:509-631-8695
Practice Address - Street 1:2200 MELROSE ST STE 7A
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-1579
Practice Address - Country:US
Practice Address - Phone:509-910-9087
Practice Address - Fax:509-631-8695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-31
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty