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General NPI Number Information
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NPI Number | 1740316207
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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 | 02/26/2007
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 815 MAIN ST
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City | MUNFORDVILLE
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State | KY
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Zip | 42765
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Country | US
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Telephone | 270-524-5444
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Fax | 270-524-4600
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Provider Business Mailing Address
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Address Line | 815 MAIN STREET
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City | MUNFORDVILLE
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State | KY
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Zip | 42765
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Country | US
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Telephone | 270-524-5444
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Fax | 270-524-4600
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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 | 9410
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License Number State | KY
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