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General NPI Number Information
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NPI Number | 1114218377
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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 | 04/22/2011
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 631 E TIPTON ST STE 2
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City | SEYMOUR
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State | IN
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Zip | 47274-3519
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Country | US
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Telephone | 812-522-4444
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Fax | 812-522-2634
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Provider Business Mailing Address
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Address Line | 631 E TIPTON ST STE 2
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City | SEYMOUR
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State | IN
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Zip | 47274-3519
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Country | US
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Telephone | 812-522-4444
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Fax | 812-522-2634
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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 | O.D.
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Telephone | 502-459-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State | IN
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