| Entity Name: | OPTICAL OUTFITTERS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 24 Mar 2014 (11 years ago) |
| Document Number: | L14000048891 |
| FEI/EIN Number | 46-5210239 |
| Address: | 242 Harbor Village Lane, Apollo Beach, FL, 33572, US |
| Mail Address: | 242 Harbor Village Lane, Apollo Beach, FL, 33572, US |
| ZIP code: | 33572 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1922497916 | 2015-01-14 | 2015-07-15 | 242 HARBOR VILLAGE LN, APOLLO BEACH, FL, 335723424, US | 242 HARBOR VILLAGE LN, APOLLO BEACH, FL, 335723424, US | |||||||||||||||||||||||||||||
|
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| Phone | +1 813-645-2022 |
Authorized person
| Name | CATHERINE YAECKEL |
| Role | OPTOMETRIST |
| Phone | 8136452022 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC4515 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002695100 |
| State | FL |
| Issuer | MEDICARE PROVIDER NUMBER |
| Number | DP715Z |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RICHARDS DARRYL R | Agent | 403 E. MADISON STREET, TAMPA, FL, 33602 |
| Name | Role | Address |
|---|---|---|
| YAECKEL CATHERINE D | Manager | 242 Harbor Village Lane, Apollo Beach, FL, 33572 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2020-03-16 | 242 Harbor Village Lane, Apollo Beach, FL 33572 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-15 | 242 Harbor Village Lane, Apollo Beach, FL 33572 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-04 |
| ANNUAL REPORT | 2023-03-02 |
| ANNUAL REPORT | 2022-03-04 |
| ANNUAL REPORT | 2021-04-12 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-17 |
| ANNUAL REPORT | 2017-02-14 |
| ANNUAL REPORT | 2016-03-31 |
| ANNUAL REPORT | 2015-04-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
