Provider Demographics
NPI:1104577972
Name:AMPLIFY MEDICAL PC
Entity type:Organization
Organization Name:AMPLIFY MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AVI
Authorized Official - Middle Name:
Authorized Official - Last Name:FACTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-321-8233
Mailing Address - Street 1:16816 CLARK AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-5702
Mailing Address - Country:US
Mailing Address - Phone:562-925-6591
Mailing Address - Fax:
Practice Address - Street 1:16816 CLARK AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-5702
Practice Address - Country:US
Practice Address - Phone:562-925-6591
Practice Address - Fax:582-867-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty