MEDICARE: LOUISVILLE OPTOMETRIC CENTERS III, PSC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1407697998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISVILLE OPTOMETRIC CENTERS III, PSC

Provider Business Mailing Address
First Line	:	8104 OLD BARDSTOWN RD STE 102
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4422
Country	:	US
Telephone Number	:	502-792-8399
Fax Number	:

Provider Business Practice Location Address
First Line	:	8104 OLD BARDSTOWN RD STE 102
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40291-4422
Country	:	US
Telephone Number	:	502-792-8399
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ROD RALLO
Credential	:
Telephone Number	:	502-459-2020

Provider Enumeration Date	:	06/06/2024
Last Update Date	:	03/12/2026

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