Healthcare Provider Details

I. General information

NPI: 1730921537
Provider Name (Legal Business Name): AMPLIFY OPTOMETRY OF CALIFORNIA PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5980 STONERIDGE DR STE 110
PLEASANTON CA
94588-2723
US

IV. Provider business mailing address

6125 LUTHER LN # 572
DALLAS TX
75225-6202
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-7330
  • Fax:
Mailing address:
  • Phone: 312-608-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MOSHE MENDELSON
Title or Position: OWNER
Credential: OD
Phone: 925-463-7330