Basic Information
| Provider Information | |||||||||
| NPI: | 1548462302 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BIFANO EYE CARE PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 26388 FORD RD | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481272854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137305020 | ||||||||
| FaxNumber: | 3137305027 | ||||||||
| Practice Location | |||||||||
| Address1: | 26388 FORD RD | ||||||||
| Address2: | |||||||||
| City: | DEARBORN HEIGHTS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481272854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3137305020 | ||||||||
| FaxNumber: | 3137305027 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2007 | ||||||||
| LastUpdateDate: | 03/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | BIFANO | ||||||||
| AuthorizedOfficialFirstName: | RHONDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3137305020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901003353 | MI | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 3216945 | 05 | MI | MEDICAID | 3216954 | 05 | MI | MEDICAID |