Healthcare Provider Details

I. General information

NPI: 1366512733
Provider Name (Legal Business Name): LOUISVILLE OPTOMETRIC CENTERS III, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 LEONARDWOOD ROAD
FRANKFORT KY
40601-4060
US

IV. Provider business mailing address

1303 SUITE 108 US 127 SOUTH
FRANKFORT KY
40601
US

V. Phone/Fax

Practice location:
  • Phone: 502-459-2020
  • Fax: 502-451-8663
Mailing address:
  • Phone: 502-875-3050
  • Fax: 502-226-4261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number5419240007
License Number StateKY

VIII. Authorized Official

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