Healthcare Provider Details

I. General information

NPI: 1407697998
Provider Name (Legal Business Name): LOUISVILLE OPTOMETRIC CENTER III, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8104 OLD BARDSTOWN RD STE 102
LOUISVILLE KY
40291-4422
US

IV. Provider business mailing address

8104 OLD BARDSTOWN RD STE 102
LOUISVILLE KY
40291-4422
US

V. Phone/Fax

Practice location:
  • Phone: 502-792-8399
  • Fax:
Mailing address:
  • Phone: 502-792-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ROD RALLO
Title or Position: OWNER
Credential: OD
Phone: 502-459-2020