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NPI Code Detail

MEDICARE: DR. ROD RALLO OD

MEDICARE: DR. ROD RALLO OD
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
1152W00000XOptometrist0936DTKY
2332H00000XEyewear SupplierKY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4P00202733OTHERKYRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2000000350896OTHERKYANTHEM BCBS
30936DTOTHERKYOD LICENSE NUMBER

General Provider Information

NPI Number : 1831181973
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROD RALLO OD
Provider Business Mailing Address
First Line : 4000 POPLAR LEVEL RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40213-1524
Country : US
Telephone Number : 502-459-2020
Fax Number : 502-456-5925
Provider Business Practice Location Address
First Line : 4000 POPLAR LEVEL RD
Second Line :
City : LOUISVILLE
State : KY
Zip : 40213-1524
Country : US
Telephone Number : 502-459-2020
Fax Number : 502-456-5925
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2005
Last Update Date : 02/19/2014

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Directions to “ DR. ROD RALLO OD” Practice Location

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