| Entity Name: | WISE OPHTHALMOLOGY GROUP, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 12 Dec 1978 (46 years ago) |
| Document Number: | 597100 |
| FEI/EIN Number | 591867494 |
| Address: | 3816 HOLLYWOOD BLVD, STE 101, HOLLYWOOD, FL, 33021, US |
| Mail Address: | 3816 HOLLYWOOD BLVD, STE 101, HOLLYWOOD, FL, 33021, US |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1437355112 | 2007-06-21 | 2008-01-25 | 3816 HOLLYWOOD BLVD, STE 101, HOLLYWOOD, FL, 330216750, US | 3816 HOLLYWOOD BLVD, STE 101, HOLLYWOOD, FL, 330216750, US | |||||||||||||||||||
|
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| Phone | +1 954-963-4990 |
| Fax | 9549631848 |
Authorized person
| Name | DR. JONATHAN F. WISE |
| Role | OWNER |
| Phone | 9549634990 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| License Number | 034543 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| WISE JONATHAN | Agent | 3816 HOLLYWOOD BLVD, HOLLYWOOD, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| WISE, JONATHAN | Manager | 3816 HOLLYWOOD BLVD STE 101, HOLLYWOOD, FL, 33021 |
| WISE LESLY S | Manager | 3816 HOLLYWOOD BVD, HOLLYWOOD, FL, 330216750 |
| WISE TODD A | Manager | 3816 HOLLYWOOD BVD, HOLLYWOOD, FL, 330216750 |
| WISE JEFFREY B | Manager | 3816 HOLLYWOOD BVD, HOLLYWOOD, FL, 330216750 |
| Name | Role | Address |
|---|---|---|
| WISE, JONATHAN | Director | 3816 HOLLYWOOD BLVD STE 101, HOLLYWOOD, FL, 33021 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000049151 | HOLLYWOOD OPHTHALMOLOGY ASSOCIATES | ACTIVE | 2020-05-04 | 2025-12-31 | No data | 3816 HOLLYWOOD BLVD, 101, HOLLYWOOD, FL, 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| NAME CHANGE AMENDMENT | 2001-07-18 | WISE OPHTHALMOLOGY GROUP, P.A. | No data |
| NAME CHANGE AMENDMENT | 1992-06-04 | FISHER OPHTHALMOLOGY GROUP, INC. | No data |
| EVENT CONVERTED TO NOTES | 1992-06-04 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
