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General NPI Number Information
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NPI Number | 1568537728
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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 | 11/22/2006
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 600 S MAIN ST
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City | SALEM
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State | IN
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Zip | 47167-1040
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Country | US
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Telephone | 812-883-2700
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Fax | 812-883-2752
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Provider Business Mailing Address
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Address Line | 600 S MAIN ST
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City | SALEM
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State | IN
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Zip | 47167-1040
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Country | US
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Telephone | 812-883-2700
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Fax | 812-883-2752
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Authorized Official
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Title or Position | OWNER AND OPTOMETRIST
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 200502740A
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License Number State | IN
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