Healthcare Provider Details

I. General information

NPI: 1861381964
Provider Name (Legal Business Name): MATTHEW FARNSWORTH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2025
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 W TENTH ST
CARSON CITY NV
89703-5170
US

IV. Provider business mailing address

111 W TENTH ST
CARSON CITY NV
89703-5170
US

V. Phone/Fax

Practice location:
  • Phone: 775-883-4664
  • Fax:
Mailing address:
  • Phone: 720-636-4718
  • Fax: 775-883-4664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1262
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003538
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: