Provider Demographics
NPI:1003806910
Name:BIFANO, CHRISTOPHER (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:
Last Name:BIFANO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12533 WOODPINE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-8177
Mailing Address - Country:US
Mailing Address - Phone:248-486-6124
Mailing Address - Fax:
Practice Address - Street 1:26388 FORD RD
Practice Address - Street 2:
Practice Address - City:DEARBORN HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48127-2854
Practice Address - Country:US
Practice Address - Phone:313-730-5020
Practice Address - Fax:313-730-5027
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3216845Medicaid
MI0M17760002Medicare PIN