MEDICARE: AMPLIFY MEDICAL PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1104577972
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMPLIFY MEDICAL PC

Provider Business Mailing Address
First Line	:	16816 CLARK AVE
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-5702
Country	:	US
Telephone Number	:	562-925-6591
Fax Number	:

Provider Business Practice Location Address
First Line	:	16816 CLARK AVE
Second Line	:
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-5702
Country	:	US
Telephone Number	:	562-925-6591
Fax Number	:	582-867-8719

Authorized Official
Title or Position	:	OWNER
Name	:	DR. AVI FACTOR
Credential	:	MD
Telephone Number	:	423-321-8233

Provider Enumeration Date	:	01/13/2022
Last Update Date	:	11/22/2022

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1700400777 — DR. RYAN DAVID LOPEZ OD
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Directions to “AMPLIFY MEDICAL PC ” Practice Location

Language	Start Address	Practice Location

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