| Entity Name: | PREMIER VISUAL HEALTH, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 14 Jun 2004 (21 years ago) |
| Date of dissolution: | 22 Sep 2017 (7 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2017 (7 years ago) |
| Document Number: | L04000044608 |
| FEI/EIN Number | 202765180 |
| Address: | 810 N. ROSE AVENUE, KISSIMMEE, FL, 34741, US |
| Mail Address: | 810 N. ROSE AVENUE, KISSIMMEE, FL, 34741, US |
| ZIP code: | 34741 |
| County: | Osceola |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1265797138 | 2012-07-06 | 2015-11-19 | 810 N ROSE AVE, KISSIMMEE, FL, 347414944, US | 810 N ROSE AVE, KISSIMMEE, FL, 347414944, US | |||||||||||||||||||||||||
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| Phone | +1 407-352-4044 |
| Fax | 4073524043 |
Authorized person
| Name | MS. JUANA P CETINA |
| Role | OWNER/PRESIDENT |
| Phone | 4073524044 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | ME86805 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 266163200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CETINA JUANA P | Agent | 810 N. ROSE AVENUE, KISSIMMEE, FL, 34741 |
| Name | Role | Address |
|---|---|---|
| CETINA JUANA P | Manager | 810 N. ROSE AVENUE, KISSIMMEE, FL, 34741 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| LC AMENDMENT | 2015-11-02 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2015-10-23 | CETINA, JUANA P | No data |
| LC STMNT OF RA/RO CHG | 2015-10-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-01-27 | 810 N. ROSE AVENUE, KISSIMMEE, FL 34741 | No data |
| CHANGE OF MAILING ADDRESS | 2015-01-27 | 810 N. ROSE AVENUE, KISSIMMEE, FL 34741 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-01-27 | 810 N. ROSE AVENUE, KISSIMMEE, FL 34741 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2016-02-23 |
| CORLCRACHG | 2015-10-23 |
| ANNUAL REPORT | 2015-01-27 |
| ANNUAL REPORT | 2014-02-17 |
| ANNUAL REPORT | 2013-01-24 |
| ANNUAL REPORT | 2012-01-23 |
| ANNUAL REPORT | 2011-01-10 |
| ANNUAL REPORT | 2010-01-08 |
| ANNUAL REPORT | 2009-04-20 |
| ANNUAL REPORT | 2008-04-29 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
