Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 4901003561 | MI |
NPI | 1003806910 |
---|---|
Provider Name | Dr. Christopher Bifano |
First Address | South Lyon, MI 48178-8177 |
Second Address | Dearborn Heights, MI 48127-2854 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/10/2005 |
Last Update Date | 31/10/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3216845 | (05) | MI |