| Entity Name: | DOCTORS EYECARE CENTER OF SW FLORIDA, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 07 Dec 2018 (6 years ago) |
| Last Event: | CONVERSION |
| Event Date Filed: | 07 Dec 2018 (6 years ago) |
| Document Number: | L18000280858 |
| FEI/EIN Number | 59-2759063 |
| Address: | 1030 IONE DRIVE, FORT MYERS, FL, 33919, US |
| Mail Address: | 1030 IONE DRIVE, FORT MYERS, FL, 33919, US |
| ZIP code: | 33919 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1669545737 | 2006-11-16 | 2022-06-07 | 5995 S POINTE BLVD, STE 111, FORT MYERS, FL, 339193273, US | 5995 S POINTE BLVD, STE 111, FORT MYERS, FL, 339193273, US | |||||||||||||||||||||||||||||||
|
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| Phone | +1 239-482-0355 |
| Fax | 2394828930 |
Authorized person
| Name | TIMOTHY E. UNDERHILL |
| Role | OWNER/MANAGER |
| Phone | 2394820355 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC001100 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 078232700 |
| State | FL |
| Issuer | MEDICAID |
| Number | 620835500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| UNDERHILL TIMOTHY E | Agent | 1030 IONE DRIVE, FORT MYERS, FL, 33919 |
| Name | Role | Address |
|---|---|---|
| UNDERHILL TIMOTHY E | Manager | 1030 IONE DRIVE, FORT MYERS, FL, 33919 |
| Name | Role | Address |
|---|---|---|
| Underhill Thomas AMember | Auth | 677 Astarias Circle, Fort Myers, FL, 33919 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000157366 | UNDERHILL EYECARE | ACTIVE | 2024-12-28 | 2029-12-31 | No data | 1565 MATTHEW DR STE 2, FORT MYERS, FL, 33907 |
| G14000075325 | VISION SOURCE OF FORT MYERS | EXPIRED | 2014-07-21 | 2024-12-31 | No data | 5995 S POINTE BLVD STE 111, FORT MYERS, FL, 33919-3273 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CONVERSION | 2018-12-07 | No data | GEN-COR CONVERSION RESULT. THE CONVERTING ENTITY WAS GP1800001129 ORIGINALLY FILED ON 10/22/2018. CONVERSION NUMBER 900000187369 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-02 |
| ANNUAL REPORT | 2023-02-28 |
| ANNUAL REPORT | 2022-01-18 |
| ANNUAL REPORT | 2021-01-18 |
| ANNUAL REPORT | 2020-02-10 |
| ANNUAL REPORT | 2019-01-04 |
| Florida Limited Liability | 2018-12-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
