| Entity Name: | P. D. LAB., INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 19 Dec 1985 (39 years ago) |
| Document Number: | H90680 |
| FEI/EIN Number | 592623098 |
| Address: | 6169 JOG ROAD, A-3, LAKE WORTH, FL, 33467, PB |
| Mail Address: | 7798 PENWOOD CT, LAKE WORTH, FL, 33467-6509 |
| ZIP code: | 33467 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1720100399 | 2007-04-04 | 2010-08-02 | 6169 JOG RD, STE A3, LAKE WORTH, FL, 334676579, US | 6169 JOG RD, STE A3, LAKE WORTH, FL, 334676579, US | |||||||||||||||||||||||||
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| Phone | +1 561-304-1234 |
| Fax | 5613041254 |
Authorized person
| Name | MR. PETER FOX |
| Role | PRESIDENT OPTICIAN |
| Phone | 5613041234 |
Taxonomy
| Taxonomy Code | 156FX1800X - Optician |
| License Number | DO1062 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 001904700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FOX PETER F | Agent | 7798 PENWOOD CT, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| FOX, PETER | President | 7798 PENWOOD CT, LAKE WORTH, FL, 33467 |
| Name | Role | Address |
|---|---|---|
| FOX, PETER | Director | 7798 PENWOOD CT, LAKE WORTH, FL, 33467 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REINSTATEMENT | 1999-10-12 | No data | No data |
| INVOLUNTARILY DISSOLVED | 1989-10-13 | No data | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
