| Entity Name: | CONGLETON EYE CARE LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 26 Jun 2015 (10 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 18 Oct 2016 (8 years ago) |
| Document Number: | L15000111597 |
| FEI/EIN Number | 47-4376014 |
| Address: | 4600 MOBILE HWY, SUITE 122, PENSACOLA, FL, 32506 |
| Mail Address: | 4600 MOBILE HWY, SUITE 9 PO BOX 139, PENSACOLA, FL, 32506 |
| ZIP code: | 32506 |
| County: | Escambia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1750761375 | 2015-06-09 | 2015-09-25 | 4600 MOBILE HWY #9, PMB 139, PENSACOLA, FL, 32506, US | 4600 MOBILE HWY, SUITE 122, PENSACOLA, FL, 32506, US | |||||||||||||||||||||||||
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| Phone | +1 850-455-0722 |
| Fax | 8504550723 |
Authorized person
| Name | JAMIE CONGLETON |
| Role | PRESIDENT |
| Phone | 8504550722 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | FLORIDA MEDICARE - INDIVIDUAL PTAN |
| Number | IG570Z |
| Issuer | MEDICARE GROUP PTAN |
| Number | IG569A |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CONGLETON JAMIE L | Agent | 4600 MOBILE HWY, PENSACOLA, FL, 32506 |
| Name | Role | Address |
|---|---|---|
| CONGLETON JAMIE L | Manager | 1470 Rolling Oaks Drive, Molino, FL, 32577 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2016-10-18 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2016-10-18 | CONGLETON, JAMIE L | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-25 |
| ANNUAL REPORT | 2023-01-13 |
| ANNUAL REPORT | 2022-01-04 |
| ANNUAL REPORT | 2021-01-08 |
| ANNUAL REPORT | 2020-02-28 |
| ANNUAL REPORT | 2019-01-18 |
| ANNUAL REPORT | 2018-03-29 |
| ANNUAL REPORT | 2017-01-12 |
| REINSTATEMENT | 2016-10-18 |
| Florida Limited Liability | 2015-06-26 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
