Provider Demographics
NPI:1366519050
Name:FARNSWORTH, MELVIN L (OD)
Entity type:Individual
Prefix:DR
First Name:MELVIN
Middle Name:L
Last Name:FARNSWORTH
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 1:2419 COMMERCIAL AVE
Mailing Address - Street 2:1610 COMMERCIAL
Mailing Address - City:ANACORTES
Mailing Address - State:WA
Mailing Address - Zip Code:98221-2727
Mailing Address - Country:US
Mailing Address - Phone:360-293-2127
Mailing Address - Fax:360-293-1354
Practice Address - Street 1:1610 COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:ANACORTES
Practice Address - State:WA
Practice Address - Zip Code:98221-2275
Practice Address - Country:US
Practice Address - Phone:360-293-2127
Practice Address - Fax:360-293-1354
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1542152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1024072Medicaid
WAT02934Medicare UPIN
WAG001145501Medicare PIN