| Entity Name: | EYELID SURGERY CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Inactive |
| Date Filed: | 26 Apr 2004 (21 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | L04000031581 |
| FEI/EIN Number | 33-1096270 |
| Address: | 15620 NEW HAMPSHIRE CT, FORT MYERS, FL 33908 |
| Mail Address: | 15620 New Hampshire Ct., Fort Myers, FL 33908 |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255325080 | 2005-09-08 | 2020-08-22 | 15620 NEW HAMPSHIRE CT, FORT MYERS, FL, 339084168, US | 15620 NEW HAMPSHIRE CT, FORT MYERS, FL, 339084168, US | |||||||||||||||||||||||||
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| Phone | +1 239-481-9995 |
| Fax | 2394819745 |
Authorized person
| Name | MR. ROBERT DUANE MARTILLA |
| Role | ADMINISTRATOR |
| Phone | 2394819995 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 1220 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BC/BS FLORIDA |
| Number | 6J5 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| LARSON, David J, Esq. | Agent | 15260 NEW HAMPSHIRE CT, FORT MYERS, FL 33908 |
| Name | Role | Address |
|---|---|---|
| LARSON, David J, Esq. | Authorized Representative | 131 S. Main Street, Chamberlain, SD 57325 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2016-03-31 | 15620 NEW HAMPSHIRE CT, FORT MYERS, FL 33908 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-03-31 | LARSON, David J, Esq. | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2004-07-12 | 15620 NEW HAMPSHIRE CT, FORT MYERS, FL 33908 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2004-07-12 | 15260 NEW HAMPSHIRE CT, FORT MYERS, FL 33908 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-03-12 |
| ANNUAL REPORT | 2016-03-31 |
| ANNUAL REPORT | 2015-01-06 |
| ANNUAL REPORT | 2014-03-31 |
| ANNUAL REPORT | 2013-05-06 |
| ANNUAL REPORT | 2012-02-08 |
| ANNUAL REPORT | 2011-04-26 |
| ANNUAL REPORT | 2010-03-09 |
| ANNUAL REPORT | 2009-03-04 |
| ANNUAL REPORT | 2008-04-29 |
Date of last update: 05 Jan 2025
Sources: Florida Department of State
