| Entity Name: | LAKE CITY EYE PHYSICIANS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 12 Nov 2003 (21 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 07 Oct 2015 (9 years ago) |
| Document Number: | L03000044942 |
| FEI/EIN Number | 200429063 |
| Address: | 621 SW BAYA DRIVE, SUITE 101, LAKE CITY, FL, 32025 |
| Mail Address: | 621 SW BAYA DRIVE, SUITE 101, LAKE CITY, FL, 32025 |
| ZIP code: | 32025 |
| County: | Columbia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235350208 | 2007-05-01 | 2020-08-22 | 621 SW BAYA DR, SUITE 101, LAKE CITY, FL, 320254240, US | 621 SW BAYA DR, SUITE 101, LAKE CITY, FL, 320254240, US | |||||||||||||||||||||||||
|
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| Phone | +1 386-754-6616 |
| Fax | 3867546615 |
Authorized person
| Name | DR. REAVES C CLOE |
| Role | OWNER |
| Phone | 3867546616 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | 0700004320 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 19899 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| COLE MELISSA R | Agent | 621 SW BAYA DRIVE, LAKE CITY, FL, 32025 |
| Name | Role | Address |
|---|---|---|
| COLE REAVES COD | Managing Member | 621 SW BAYA DRIVE, LAKE CITY, FL, 32025 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2015-10-07 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-06-26 | COLE, MELISSA R | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2013-04-30 | 621 SW BAYA DRIVE, SUITE 101, LAKE CITY, FL 32025 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-22 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-04-07 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-28 |
| ANNUAL REPORT | 2019-04-30 |
| ANNUAL REPORT | 2018-04-30 |
| ANNUAL REPORT | 2017-04-04 |
| ANNUAL REPORT | 2016-04-29 |
| REINSTATEMENT | 2015-10-07 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
