| Entity Name: | OCULOFACIAL SURGERY AND COSMETIC LASER INSTITUTE, LLC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 05 Jun 2020 (5 years ago) |
| Document Number: | L20000149092 |
| FEI/EIN Number | 85-1662669 |
| Address: | 24420 State Road 54, Lutz, FL 33559 |
| Mail Address: | 24420 State Road 54, Lutz, FL 33559 |
| ZIP code: | 33559 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1952982886 | 2021-04-21 | 2021-05-12 | 24420 STATE ROAD 54, LUTZ, FL, 335597303, US | 24420 STATE ROAD 54, LUTZ, FL, 335597303, US | |||||||||||||||||||
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| Phone | +1 813-303-0123 |
| Fax | 8135879861 |
Authorized person
| Name | DR. ROSHNI U RANJIT-REEVES |
| Role | OWNER / PROVIDER |
| Phone | 8133030123 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | No |
| Taxonomy Code | 207WX0200X - Ophthalmic Plastic and Reconstructive Surgery Physician |
| Is Primary | Yes |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OCULOFACIAL SURGERY AND COSMETIC LASER INSTITUTE 401(K) PLAN | 2023 | 851662669 | 2024-05-10 | OCULOFACIAL SURGERY AND COSMETIC LASER INSTITUTE | 3 | |||||||||||||||||||||||||||||||
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| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2024-05-10 |
| Name of individual signing | QIAN LIU |
| Valid signature | Filed with authorized/valid electronic signature |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2022-01-01 |
| Business code | 621399 |
| Sponsor’s telephone number | 8133030123 |
| Plan sponsor’s address | 24420 STATE ROAD 54, LUTZ, FL, 33559 |
Plan administrator’s name and address
| Administrator’s EIN | 474474775 |
| Plan administrator’s name | GUIDELINE, INC. |
| Plan administrator’s address | 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010 |
| Administrator’s telephone number | 8882283491 |
Signature of
| Role | Plan administrator |
| Date | 2023-05-28 |
| Name of individual signing | CHRISTINE RIMER |
| Valid signature | Filed with authorized/valid electronic signature |
| Name | Role | Address |
|---|---|---|
| SMITH, ERIN | Agent | 101 EAST KENNEDY BLVD SUITE 2800, TAMPA, FL 33602 |
| Name | Role | Address |
|---|---|---|
| RANJIT-REEVES, ROSHNI | Manager | 2511 N. RIVERSIDE DRIVE, TAMPA, FL 33602 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF MAILING ADDRESS | 2022-04-11 | 24420 State Road 54, Lutz, FL 33559 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-04-15 | 24420 State Road 54, Lutz, FL 33559 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-13 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-04-15 |
| Florida Limited Liability | 2020-06-05 |
Date of last update: 15 Jan 2025
Sources: Florida Department of State
