Provider Demographics
NPI:1952385536
Name:FARNSWORTH, DANIEL DT IV (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DT
Last Name:FARNSWORTH
Suffix:IV
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 1:137 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV823OD152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0149630000Medicaid
WV0148280001OtherADMINISTAR FEDERAL
WV0148280001OtherADMINISTAR FEDERAL
0148280001Medicare NSC
WVT32494Medicare UPIN