| Entity Name: | ROBERT B. SCOTT OCULARISTS OF FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 14 Dec 1978 (46 years ago) |
| Document Number: | 597345 |
| FEI/EIN Number | 581345960 |
| Address: | 3500 E FLETCHER AVENUE, SUITE 509, TAMPA, FL, 33613-4791, US |
| Mail Address: | 111 N WABASH AVENUE, SUITE 1516, CHICAGO, IL, 60602, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1154423416 | 2006-09-05 | 2009-07-20 | 111 N WABASH AVE, SUITE 1516, CHICAGO, IL, 606023066, US | 3500 E FLETCHER AVE, SUITE 509, TAMPA, FL, 336134793, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 312-782-3558 |
| Fax | 3123724449 |
| Phone | +1 813-977-7676 |
| Fax | 8139771999 |
Authorized person
| Name | BONNY J SCOTT |
| Role | OFFICE MANAGER/TREASURER |
| Phone | 3127823558 |
Taxonomy
| Taxonomy Code | 335E00000X - Prosthetic/Orthotic Supplier |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AMERIGROUP |
| Number | 231983 |
| Issuer | WELLCARE |
| Number | N3179 |
| Issuer | HEALTHEASE |
| Number | N3179 |
| Issuer | BCBS TN |
| Number | 4017986 |
| State | TN |
| Issuer | MEDICAID |
| Number | 027891200 |
| State | FL |
| Issuer | AVMED |
| Number | 214220 |
| Issuer | STAYWELL |
| Number | N3179 |
| Issuer | AETNA |
| Number | 2436832 |
| Issuer | BSBS |
| Number | M0331 |
| Issuer | CITRUS |
| Number | 10633501 |
| Name | Role | Address |
|---|---|---|
| SCOTT VIVIAN | Agent | 3005 N. BEACH RD, ENGLEWOOD, FL, 34223 |
| Name | Role | Address |
|---|---|---|
| SCOTT ROBERT B | Treasurer | 3005 N. BEACH RD., ENGLEWOOD, FL, 34223 |
| SCOTT BONNY | Treasurer | 12 N. PINE ST., MOUNT PROSPECT, IL, 60056 |
| Name | Role | Address |
|---|---|---|
| SCOTT ROBERT B | Director | 3005 N. BEACH RD., ENGLEWOOD, FL, 34223 |
| Name | Role | Address |
|---|---|---|
| SCOTT, VIVIAN A. | Secretary | 3005 N. BEACH RD., ENGLEWOOD, FL, 34223 |
| Name | Role | Address |
|---|---|---|
| SCOTT ROLAND B. | President | 12 N. PINE ST., MT. PROSPECT, IL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
