Provider Demographics
NPI:1164103669
Name:LOUISVILLE OPTOMETRIC CENTERS III, PSC
Entity Type:Organization
Organization Name:LOUISVILLE OPTOMETRIC CENTERS III, PSC
Other - Org Name:VISIONFIRST
Other - Org Type:Doing Business As
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 1:4000 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:502-459-3136
Mailing Address - Fax:502-456-9121
Practice Address - Street 1:2618 RING RD STE 108
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9118
Practice Address - Country:US
Practice Address - Phone:270-765-1128
Practice Address - Fax:270-854-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty