| Entity Name: | COREN EYE GROUP, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Aug 2017 (7 years ago) |
| Document Number: | L17000174493 |
| FEI/EIN Number | 82-2457970 |
| Address: | 112 E DIXIE AVE, LEESBURG, AL, 34748, US |
| Mail Address: | 112 E DIXIE AVE, LEESBURG, FL, 34748, US |
| ZIP code: | 34748 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1588182562 | 2017-08-30 | 2017-12-06 | 4137 BRIAR GATE LN, WINTER GARDEN, FL, 347875521, US | 112 E DIXIE AVE, LEESBURG, FL, 347486350, US | |||||||||||||||||||||||||||||
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| Phone | +1 407-256-3763 |
| Fax | 4073867664 |
| Phone | +1 352-787-1956 |
| Fax | 3523656690 |
Authorized person
| Name | DR. ANDREW VU TRAN |
| Role | AUTHORIZED MEMBER |
| Phone | 4072563763 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | 4108 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 621137200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| TRAN ANDREW | Agent | 4137 BRIAR GATE LANE, WINTER GARDEN, FL, 34878 |
| Name | Role | Address |
|---|---|---|
| TRAN ANDREW | Manager | 12 E. DIXIE AVE, LEESBURG, FL, 34787 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000098092 | EYECARE CENTER OF LEESBURG | EXPIRED | 2017-08-29 | 2022-12-31 | No data | 112 E. DIXIE AVENUE, LEESBURG, FL, 34748 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-17 | 112 E DIXIE AVE, LEESBURG, AL 34748 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-17 | 112 E DIXIE AVE, LEESBURG, AL 34748 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-17 | 4137 BRIAR GATE LANE, WINTER GARDEN, FL 34878 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-03-14 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-02-01 |
| ANNUAL REPORT | 2020-06-29 |
| ANNUAL REPORT | 2019-04-16 |
| ANNUAL REPORT | 2018-04-17 |
| Florida Limited Liability | 2017-08-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
