| Entity Name: | TAMPA BAY OPHTHALMIC PLASTICS, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 10 Mar 2020 (5 years ago) |
| Document Number: | L20000086202 |
| FEI/EIN Number | 85-0556985 |
| Address: | 2963 Gulf to Bay Blvd, Clearwater, FL, 33759, US |
| Mail Address: | 2963 Gulf to Bay Blvd, Clearwater, FL, 33759, US |
| ZIP code: | 33759 |
| County: | Pinellas |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1811511207 | 2020-06-02 | 2020-08-10 | 2963 GULF TO BAY BLVD, STE 267, CLEARWATER, FL, 337594259, US | 2963 GULF TO BAY BLVD, STE 267, CLEARWATER, FL, 337594259, US | |||||||||||||||||||
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| Phone | +1 727-285-8006 |
Authorized person
| Name | KENDRA DEANGELIS |
| Role | OWNER |
| Phone | 7272858006 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | CAQH |
| Number | 1380996 |
| State | FL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TAMPA BAY OPHTHALMIC PLASTICS 401(K) PROFIT SHARING PLAN & TRUST | 2021 | 850556985 | 2022-05-24 | TAMPA BAY OPHTHALMIC PLASTICS | 2 | |||||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2022-05-24 |
| Name of individual signing | KENDRA DEANGELIS |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2020-01-01 |
| Business code | 339110 |
| Sponsor’s telephone number | 7272858006 |
| Plan sponsor’s address | 2963 GULF TO BAY BLVD, SUITE 267, CLEARWATER, FL, 33759 |
Signature of
| Role | Plan administrator |
| Date | 2021-06-03 |
| Name of individual signing | KENDRA DEANGELIS |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| DEANGELIS KENDRA D | Agent | 1206 WESTLEY STREET, SAFETY HARBOR, FL, 34695 |
| Name | Role | Address |
|---|---|---|
| DEANGELIS KENDRA D | Authorized Member | 2963 Gulf to Bay Blvd, Clearwater, FL, 33759 |
| DEANGELIS JON | Authorized Member | 1206 WESTLEY STREET, SAFETY HARBOR, FL, 34695 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-05-12 | 2963 Gulf to Bay Blvd, Suite 267, Clearwater, FL 33759 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-01-18 | 2963 Gulf to Bay Blvd, Suite 267, Clearwater, FL 33759 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-08 |
| ANNUAL REPORT | 2023-03-29 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-01-18 |
| Florida Limited Liability | 2020-03-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
