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Individual

DR. ROD RALLO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
4000 POPLAR LEVEL RD, LOUISVILLE, KY 40213-1524
(502) 459-2020
(502) 456-5925
Mailing address
4000 POPLAR LEVEL RD, LOUISVILLE, KY 40213-1524
(502) 459-2020
(502) 456-5925

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0936DT
KY
332H00000X
Eyewear Supplier
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000350896
ANTHEM BCBS
KY
01
0936DT
OD LICENSE NUMBER
KY
05
77009363
KY
01
P00202733
RR MEDICARE
KY
Enumeration date
08/16/2005
Last updated
02/19/2014
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