Provider Demographics
NPI:1457735516
Name:DANIEL DT FARNSWORTH IV PLLC
Entity Type:Organization
Organization Name:DANIEL DT FARNSWORTH IV PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNSWORTH
Authorized Official - Suffix:IV
Authorized Official - Credentials:OD
Authorized Official - Phone:304-269-2020
Mailing Address - Street 1:137 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:WV
Mailing Address - Zip Code:26452-1944
Mailing Address - Country:US
Mailing Address - Phone:304-269-2020
Mailing Address - Fax:304-269-2020
Practice Address - Street 1:137 MAIN AVE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:WV
Practice Address - Zip Code:26452-1944
Practice Address - Country:US
Practice Address - Phone:304-269-2020
Practice Address - Fax:304-269-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV823-OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty