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General NPI Number Information
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NPI Number | 1831181973
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Entity Type | Individual
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Provider Name | ROD RALLO OD
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Gender | Male
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Dates
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Enumeration Date | 08/16/2005
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Last Update Date | 02/19/2014
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Provider Practice Location 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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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 |
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Name |
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Credential |
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Telephone |
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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 | 0936DT
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License Number State | KY
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Taxonomy #2
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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 | KY
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