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NPI Code Detail

MEDICARE: LOUISVILLE OPTOMETRIC CENTERS III, PSC

MEDICARE: LOUISVILLE OPTOMETRIC CENTERS III, PSC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier

General Provider Information

NPI Number : 1538938725
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOUISVILLE OPTOMETRIC CENTERS III, PSC
Provider Business Mailing Address
First Line : 4202 POPLAR LEVEL RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40213-1528
Country : US
Telephone Number : 502-459-2020
Fax Number :
Provider Business Practice Location Address
First Line : 4202 POPLAR LEVEL RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40213-1528
Country : US
Telephone Number : 502-459-2020
Fax Number :
Authorized Official
Title or Position : OWNER/OPTOMETRIST
Name : ROD RALLO
Credential : OD
Telephone Number : 502-459-2020
Provider Enumeration Date : 12/28/2023
Last Update Date : 12/28/2023

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Directions to “LOUISVILLE OPTOMETRIC CENTERS III, PSC ” Practice Location

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