| Entity Name: | NORTH FLORIDA REGIONAL EYECARE, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 29 Aug 1975 (49 years ago) |
| Document Number: | 483614 |
| FEI/EIN Number | 591617237 |
| Mail Address: | 5354 PEMBRIDGE PL, Tallahassee, FL, 32309, US |
| Address: | 1404 E. RACHEL LANE, TALLAHASSEE, FL, 32308, US |
| ZIP code: | 32308 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902190895 | 2011-06-08 | 2017-01-09 | 1400 VILLAGE SQUARE BLVD, SUITE 3-165, TALLAHASSEE, FL, 323121250, US | 1905 CAPITAL CIR NE, TALLAHASSEE, FL, 323084421, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-222-3937 |
| Fax | 8508770206 |
Authorized person
| Name | JAMES A STEPHENS |
| Role | PRESIDENT |
| Phone | 8508934005 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC935 |
| State | FL |
| Is Primary | No |
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | ME71349 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 24269 |
| State | FL |
| Issuer | MEDICAID |
| Number | 620174100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| VAN ASTEN HALLEY S | Agent | 5354 PEMBRIDGE PL, Tallahassee, FL, 32309 |
| Name | Role | Address |
|---|---|---|
| STEPHENS,JAMES A. | President | 1404 E RACHEL LANE, TALLAHASSEE, FL, 32308 |
| Name | Role | Address |
|---|---|---|
| Van Asten Chris | Chief Operating Officer | 5354 PEMBRIDGE PL, Tallahassee, FL, 32309 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| AMENDMENT AND NAME CHANGE | 2015-05-12 | NORTH FLORIDA REGIONAL EYECARE, PA | No data |
| NAME CHANGE AMENDMENT | 2007-04-03 | JAMES A. STEPHENS, O.D., AND ASSOCIATES, P.A. | No data |
| NAME CHANGE AMENDMENT | 1991-09-19 | JAMES A. STEPHENS, O.D. AND ROBERT A. ORSILLO, O.D., P.A. | No data |
| NAME CHANGE AMENDMENT | 1980-05-20 | JAMES A. STEPHENS, O.D., P.A. | No data |
| NAME CHANGE AMENDMENT | 1976-03-17 | DRS. STEPHENS AND BARKER, P.A. OPTOMETRIST | No data |
Date of last update: 02 Jan 2025
Sources: Florida Department of State
