| Entity Name: | ABITA EYE GROUP LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: |
Florida Limited Liability Company
ABITA EYE GROUP LLC is structured as a Limited Liability Company (LLC), a common business structure that offers its members limited liability protection, separating their personal assets from the company's debts and obligations. |
| Status: |
Active
The business entity is active. This status indicates that the business is currently operating and compliant with state regulations, suggesting a lower risk profile for lenders and potentially better creditworthiness. |
| Date Filed: | 16 Feb 2018 (7 years ago) |
| Document Number: | L18000042893 |
| FEI/EIN Number |
83-0653677
Federal Employer Identification (FEI) Number assigned by the IRS. |
| Address: | 4330 Sheridan Street, 102B, Hollywood, FL 33021 |
| Mail Address: | 4330 Sheridan Street, 102B, Hollywood, FL 33021 |
| ZIP code: | 33021 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1659862753 | 2018-05-23 | 2024-09-13 | 4330 SHERIDAN ST # 102B, HOLLYWOOD, FL, 330211407, US | 4330 SHERIDAN ST # 102B, HOLLYWOOD, FL, 330211407, US | |||||||||||||||||||||||||||||
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| Phone | +1 954-287-2010 |
| Fax | 3057231910 |
Authorized person
| Name | AUSTIN BACH |
| Role | OWNER |
| Phone | 9542872010 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| Is Primary | No |
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | No |
| Taxonomy Code | 207WX0110X - Pediatric Ophthalmology and Strabismus Specialist Physician Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 103302400 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ABITA EYE GROUP, LLC RETIREMENT TRUST | 2023 | 830653677 | 2024-10-14 | ABITA EYE GROUP, LLC | 7 | |||||||||||||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2024-10-14 |
| Name of individual signing | AILEEN ARANA |
| Valid signature | Filed with authorized/valid electronic signature |
| Role | Employer/plan sponsor |
| Date | 2024-10-14 |
| Name of individual signing | AILEEN ARANA |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-02-01 |
| Business code | 541600 |
| Sponsor’s telephone number | 7864654836 |
| Plan sponsor’s address | 10676 NW 19TH ST, DORAL, FL, 33172 |
Signature of
| Role | Plan administrator |
| Date | 2023-07-10 |
| Name of individual signing | PLAN SPONSOR |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2021-02-01 |
| Business code | 541600 |
| Sponsor’s telephone number | 7864654836 |
| Plan sponsor’s address | 10676 NW 19TH ST, DORAL, FL, 33172 |
Signature of
| Role | Plan administrator |
| Date | 2022-07-21 |
| Name of individual signing | PLAN SPONSOR |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| Bach, Austin | Agent | 4330 Sheridan Street, 102B, Hollywood, FL 33021 |
| Bach, Austin, DO | Owner | 4330 Sheridan Street, 102B Hollywood, FL 33021 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-02 | 4330 Sheridan Street, 102B, Hollywood, FL 33021 | - |
| CHANGE OF MAILING ADDRESS | 2022-02-02 | 4330 Sheridan Street, 102B, Hollywood, FL 33021 | - |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-02 | 4330 Sheridan Street, 102B, Hollywood, FL 33021 | - |
| REGISTERED AGENT NAME CHANGED | 2020-01-14 | Bach, Austin | - |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-17 |
| ANNUAL REPORT | 2023-04-28 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-01-14 |
| ANNUAL REPORT | 2019-04-05 |
| Florida Limited Liability | 2018-02-16 |
| Loan Number | Loan Funded Date | SBA Origination Office Code | Loan Delivery Method | Borrower Street Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1201808605 | 2021-03-12 | 0455 | PPS | 10676 NW 19th St, Doral, FL, 33172-2542 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 3059747209 | 2020-04-16 | 0455 | PPP | 10676 19TH ST, DORAL, FL, 33172-2542 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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Date of last update: 17 Feb 2025
Sources: Florida Department of State
