Provider Demographics
NPI:1285623207
Name:BIFANO, RHONDA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:MARIE
Last Name:BIFANO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:11310 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-9538
Mailing Address - Country:US
Mailing Address - Phone:248-486-3260
Mailing Address - Fax:248-446-1146
Practice Address - Street 1:317 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-2034
Practice Address - Country:US
Practice Address - Phone:248-446-1146
Practice Address - Fax:248-446-1350
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI49013353152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3216954Medicaid
MI3216954Medicaid
MI1058770001Medicare NSC