Provider Demographics
NPI:1134111271
Name:LOUISVILLE OPTOMETRIC CENTERS III, PSC
Entity Type:Organization
Organization Name:LOUISVILLE OPTOMETRIC CENTERS III, PSC
Other - Org Name:VISION FIRST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OD 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 1:4000 POPLAR LEVEL RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-1524
Mailing Address - Country:US
Mailing Address - Phone:502-451-0332
Mailing Address - Fax:502-456-9121
Practice Address - Street 1:4000 POPLAR LEVEL RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-1524
Practice Address - Country:US
Practice Address - Phone:502-451-0332
Practice Address - Fax:502-456-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200502740Medicaid
KY7100010580Medicaid
IN300024371Medicaid
KY5419240008Medicare NSC
IN200502740Medicaid
IN5419240009Medicare NSC
KY5419240010Medicare NSC
IN5419240013Medicare NSC
KY9410Medicare PIN
IN221390Medicare PIN
KY5419240005Medicare NSC
KY5419240011Medicare NSC
IN5419240006Medicare NSC
KY5419240007Medicare NSC
IN5419240014Medicare NSC
KY5419240012Medicare NSC