| Entity Name: | FLORIDA EYE AND LASER INSTITUTE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 29 Sep 2003 (21 years ago) |
| Document Number: | L03000038021 |
| FEI/EIN Number | 300200937 |
| Address: | 3195 TAMIAMI TRAIL, SUITE B, PORT CHARLOTTE, FL, 33952 |
| Mail Address: | 3195 TAMIAMI TRAIL, SUITE B, PORT CHARLOTTE, FL, 33952 |
| ZIP code: | 33952 |
| County: | Charlotte |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215123831 | 2007-09-18 | 2013-06-13 | 3195 TAMIAMI TRL, PORT CHARLOTTE, FL, 339528034, US | 3195 TAMIAMI TRL, PORT CHARLOTTE, FL, 339528034, US | |||||||||||||||||||||||||
|
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| Phone | +1 941-883-2020 |
| Fax | 9418833938 |
Authorized person
| Name | DR. JOSEPH A HEGLEH |
| Role | PRESIDENT |
| Phone | 9418832020 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | 81459 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD OF FLORIDA |
| Number | 58829 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HEGLEH JOSEPH M | Agent | 3195 TAMIAMI TRAIL SUITE B, PORT CHARLOTTE, FL, 33952 |
| Name | Role | Address |
|---|---|---|
| HEGLEH JOSEPH M | Managing Member | 3195 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G15000010690 | FACE & SKIN SURGERY CENTER | ACTIVE | 2015-01-30 | 2025-12-31 | No data | 3195 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952 |
| G15000010693 | PHOENICIA MED SPA | ACTIVE | 2015-01-30 | 2025-12-31 | No data | 3195 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952 |
| G15000010695 | MODA OPTIQUE | ACTIVE | 2015-01-30 | 2025-12-31 | No data | 3195 TAMIAMI TRAIL, PORT CHARLOTTE, FL, 33952 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-04-26 |
| ANNUAL REPORT | 2021-04-21 |
| ANNUAL REPORT | 2020-06-22 |
| ANNUAL REPORT | 2019-04-26 |
| ANNUAL REPORT | 2018-03-19 |
| ANNUAL REPORT | 2017-04-20 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-02-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
