Healthcare Provider Details

I. General information

NPI: 1760163893
Provider Name (Legal Business Name): LOUISVILLE OPTOMETRIC CENTERS III, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 POPLAR LEVEL RD
LOUISVILLE KY
40213-1528
US

IV. Provider business mailing address

4202 POPLAR LEVEL RD
LOUISVILLE KY
40213-1528
US

V. Phone/Fax

Practice location:
  • Phone: 502-459-2020
  • Fax:
Mailing address:
  • Phone: 502-459-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

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