| Entity Name: | COMPREHENSIVE RETINA CONSULTANTS, PLLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Sep 2017 (7 years ago) |
| Document Number: | L17000191445 |
| FEI/EIN Number | 82-2809255 |
| Address: | 1501 N US HWY 441, Bldg 1100 Suite 1106, THE VILLAGES, FL, 32159, US |
| Mail Address: | 6205 N.W. 81ST DR., GAINESVILLE, FL, 32653 |
| ZIP code: | 32159 |
| County: | Lake |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831608496 | 2017-09-27 | 2017-10-13 | 6205 NW 81ST DR, GAINESVILLE, FL, 326532979, US | 1501 N US HIGHWAY 441 STE 1106, THE VILLAGES, FL, 321596800, US | |||||||||||||||||||||||||
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| Phone | +1 352-562-6058 |
| Phone | +1 352-562-5350 |
Authorized person
| Name | DR. SHALESH KAUSHAL |
| Role | OWNER |
| Phone | 3525626058 |
Taxonomy
| Taxonomy Code | 207WX0107X - Retina Specialist (Ophthalmology) Physician |
| License Number | ME86573 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 004500300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KAUSHAL SHALESH | Agent | 6205 N.W. 81ST DR., GAINESVILLE, FL, 32653 |
| Name | Role | Address |
|---|---|---|
| Kaushal Monika | Auth | 6205 NW 81ST DRIVE, GAINESVILLE, FL, 32653 |
| Name | Role | Address |
|---|---|---|
| Kaushal Shalesh | Manager | 6205 NW 81st DR, Gainesville, FL, 32653 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-29 | 1501 N US HWY 441, Bldg 1100 Suite 1106, THE VILLAGES, FL 32159 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-04-29 |
| ANNUAL REPORT | 2022-03-25 |
| ANNUAL REPORT | 2021-04-30 |
| ANNUAL REPORT | 2020-04-21 |
| ANNUAL REPORT | 2019-03-27 |
| ANNUAL REPORT | 2018-04-29 |
| Florida Limited Liability | 2017-09-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
