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General NPI Number Information
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NPI Number | 1033267091
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Entity Type | Organization
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Legal Business Name | LOUISVILLE OPTOMETRIC CENTERS III PSC
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 11/30/2015
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Provider Practice Location Address
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Address Line | 2525 ELIZABETHTOWN RD
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City | LEITCHFIELD
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State | KY
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Zip | 42754-9120
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Country | US
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Telephone | 270-287-2020
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Fax | 270-259-5660
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Provider Business Mailing Address
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Address Line | 4000 POPLAR LEVEL RD
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City | LOUISVILLE
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State | KY
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Zip | 40213-1524
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Country | US
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Telephone | 502-459-2020
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Fax | 502-456-5925
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROD L. RALLO
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Credential | OD
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Telephone | 502-813-8910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1450DT
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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