MEDICARE: AMPLIFY PHYSICIANS OF CALIFORNIA 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	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1659113439
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMPLIFY PHYSICIANS OF CALIFORNIA PC

Provider Business Mailing Address
First Line	:	6125 LUTHER LN # 572
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75225-6202
Country	:	US
Telephone Number	:	312-608-4584
Fax Number	:

Provider Business Practice Location Address
First Line	:	1010 W FREMONT AVE STE 200
Second Line	:
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3019
Country	:	US
Telephone Number	:	408-738-6200
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DAVID MARK
Credential	:	MD
Telephone Number	:	408-738-6200

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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