Healthcare Provider Details

I. General information

NPI: 1588345938
Provider Name (Legal Business Name): LOUISVILLE OPTOMETRIC CENTERS III, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2618 RING RD STE 108
ELIZABETHTOWN KY
42701-9118
US

IV. Provider business mailing address

2618 RING RD STE 108
ELIZABETHTOWN KY
42701-9118
US

V. Phone/Fax

Practice location:
  • Phone: 270-765-1128
  • Fax: 270-854-1641
Mailing address:
  • Phone: 270-765-1128
  • Fax: 270-854-1641

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ROD RALLO
Title or Position: OWNER/OPTOMETRIST
Credential: OD
Phone: 502-459-2020