| Entity Name: | PRIMARY EYE CARE CENTER, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 22 Apr 2021 (4 years ago) |
| Document Number: | L21000188596 |
| FEI/EIN Number | 86-3729135 |
| Address: | 323 PAGE BACON ROAD, UNIT 13, MARY ESTHER, FL, 32569 |
| Mail Address: | 323 PAGE BACON ROAD, UNIT 13, MARY ESTHER, FL, 32569 |
| ZIP code: | 32569 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1477692135 | 2007-02-06 | 2018-06-21 | 323 PAGE BACON RD, SUITE 13, MARY ESTHER, FL, 325691610, US | 323 PAGE BACON RD, SUITE 13, MARY ESTHER, FL, 325691610, US | |||||||||||||||||||||||||
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| Phone | +1 850-243-7100 |
| Fax | 8502436555 |
Authorized person
| Name | DR. JOSEPH M BAZARTE |
| Role | OWNER |
| Phone | 8502432020 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC001596 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 620189001 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BAZARTE JOSEPH | Agent | 433 NORTH COUNTY HWY 393, SANTA ROSA BEACH, FL, 32459 |
| Name | Role | Address |
|---|---|---|
| BAZARTE JOSEPH | Manager | 323 PAGE BACON ROAD, UNIT 13, MARY ESTHER, FL, 32569 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-16 |
| ANNUAL REPORT | 2023-02-07 |
| ANNUAL REPORT | 2022-02-02 |
| Florida Limited Liability | 2021-04-22 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
