Healthcare Provider Details

I. General information

NPI: 1104577972
Provider Name (Legal Business Name): AMPLIFY MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16816 CLARK AVE
BELLFLOWER CA
90706-5702
US

IV. Provider business mailing address

16816 CLARK AVE
BELLFLOWER CA
90706-5702
US

V. Phone/Fax

Practice location:
  • Phone: 562-925-6591
  • Fax: 582-867-8719
Mailing address:
  • Phone: 562-925-6591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. AVI FACTOR
Title or Position: OWNER
Credential: MD
Phone: 423-321-8233