Healthcare Provider Details

I. General information

NPI: 1821164740
Provider Name (Legal Business Name): LOUISVILLE OPTOMETRIC CENTERS, III PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4326 CHARLESTOWN RD # 2
NEW ALBANY IN
47150-9568
US

IV. Provider business mailing address

4326 CHARLESTOWN RD SUITE 2
NEW ALBANY IN
47150-8542
US

V. Phone/Fax

Practice location:
  • Phone: 812-945-0023
  • Fax: 812-945-0291
Mailing address:
  • Phone: 812-945-0023
  • Fax: 812-945-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number200502740B
License Number StateIN

VIII. Authorized Official

Name: DR. ROD L. RALLO
Title or Position: OWNER AND OPTOMETRIST
Credential: O.D.
Phone: 502-459-2020