| Entity Name: | WELLS VISION AND LASER EYE CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 12 Dec 2011 (13 years ago) |
| Document Number: | L11000139417 |
| FEI/EIN Number | 45-4043767 |
| Address: | 36086 Emerald Coast Pkwy, Destin, FL 32541 |
| Mail Address: | 36086 Emerald Coast Pkwy, Destin, FL 32541 |
| ZIP code: | 32541 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356498232 | 2007-01-04 | 2012-05-16 | 4012 COMMONS DR W STE 110, DESTIN, FL, 325418424, US | 4012 COMMONS DR W STE 110, DESTIN, FL, 325418424, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 850-424-6677 |
| Fax | 8504247271 |
Authorized person
| Name | DR. KEVIN W WELLS |
| Role | PRESIDENT/OWNER |
| Phone | 8504246677 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | 2263 |
| State | OK |
| Is Primary | Yes |
| Taxonomy Code | 332H00000X - Eyewear Supplier |
| License Number | 2263 |
| State | OK |
| Is Primary | No |
Other Provider Identifiers
| Issuer | DME SUPPLIER |
| Number | 1315210001 |
| State | OK |
| Issuer | MEDICAID |
| Number | 100763300A |
| State | OK |
| Name | Role | Address |
|---|---|---|
| Wells, Kevin | Agent | 36086 Emerald Coast Pkwy, Destin, FL 32541 |
| Name | Role | Address |
|---|---|---|
| WELLS, KEVIN | Manager | 36086 Emerald Coast Pkwy, Destin, FL 32541 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-27 | 36086 Emerald Coast Pkwy, Destin, FL 32541 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-27 | 36086 Emerald Coast Pkwy, Destin, FL 32541 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-27 | 36086 Emerald Coast Pkwy, Destin, FL 32541 | No data |
| REGISTERED AGENT NAME CHANGED | 2013-04-24 | Wells, Kevin | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-30 |
| ANNUAL REPORT | 2023-04-25 |
| ANNUAL REPORT | 2022-01-24 |
| ANNUAL REPORT | 2021-01-12 |
| ANNUAL REPORT | 2020-01-27 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-04-09 |
| ANNUAL REPORT | 2017-01-30 |
| ANNUAL REPORT | 2016-04-27 |
| ANNUAL REPORT | 2015-04-27 |
Date of last update: 23 Jan 2025
Sources: Florida Department of State
