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General NPI Number Information
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NPI Number | 1104577972
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Entity Type | Organization
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Legal Business Name | AMPLIFY MEDICAL PC
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Dates
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Enumeration Date | 01/13/2022
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Last Update Date | 11/22/2022
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Provider Practice Location Address
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Address Line | 16816 CLARK AVE
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City | BELLFLOWER
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State | CA
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Zip | 90706-5702
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Country | US
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Telephone | 562-925-6591
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Fax | 582-867-8719
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Provider Business Mailing Address
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Address Line | 16816 CLARK AVE
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City | BELLFLOWER
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State | CA
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Zip | 90706-5702
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Country | US
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Telephone | 562-925-6591
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AVI FACTOR
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Credential | MD
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Telephone | 423-321-8233
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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