Provider Demographics
NPI:1689415176
Name:LOUISVILLE OPTOMETRIC CENTER III, PSC
Entity type:Organization
Organization Name:LOUISVILLE OPTOMETRIC CENTER III, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROD
Authorized Official - Middle Name:
Authorized Official - Last Name:RALLO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-459-2020
Mailing Address - Street 1:11809 STANDIFORD PLAZA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-5907
Mailing Address - Country:US
Mailing Address - Phone:502-964-9400
Mailing Address - Fax:
Practice Address - Street 1:11809 STANDIFORD PLAZA DR STE 1
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-5907
Practice Address - Country:US
Practice Address - Phone:502-964-9400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-06
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier