1669545554 NPI number — LOUISVILLE OPTOMETRIC CENTERS, III PSC

Table of content: MARIE MAGGIE DUVERT RPH (NPI 1326739574)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669545554 NPI number — LOUISVILLE OPTOMETRIC CENTERS, III PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUISVILLE OPTOMETRIC CENTERS, III PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VISIONFIRST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669545554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 POPLAR LEVEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40213-1524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-459-2020
Provider Business Mailing Address Fax Number:
502-456-9121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 POPLAR LEVEL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40213-1524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-459-2020
Provider Business Practice Location Address Fax Number:
502-456-9121
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RALLO
Authorized Official First Name:
ROD
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER AND OPTOMETRIST
Authorized Official Telephone Number:
502-459-2020

Provider Taxonomy Codes

  • Taxonomy code: 332H00000X , with the licence number:  5419240010 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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