| Entity Name: | OPTIC PLANET LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 09 Dec 2022 (2 years ago) |
| Document Number: | L22000517897 |
| FEI/EIN Number | 92-1291850 |
| Address: | 3170 N FEDERAL HWY, STE 100M, LIGHTHOUSE POINT, FL 33064 UN |
| Mail Address: | 3170 N FEDERAL HWY, STE 100M, LIGHTHOUSE POINT, FL 33064 UN |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134800030 | 2023-07-25 | 2023-07-26 | 15332 NW 79TH CT, MIAMI LAKES, FL, 330165808, US | 15332 NW 79TH CT, MIAMI LAKES, FL, 330165808, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 305-821-0304 |
| Fax | 3055580641 |
Authorized person
| Name | MS. DENISE MARTIN |
| Role | BILLER |
| Phone | 3058210304 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | NPI |
| Number | 1669133625 |
| State | FL |
| Issuer | NPI |
| Number | 1285159178 |
| State | FL |
| Issuer | NPI |
| Number | 1811144850 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GREEN, GEORGE | Agent | 3170 N FEDERAL HWY, STE 100M, LIGHTHOUSE POINT, FL 33064 |
| Name | Role | Address |
|---|---|---|
| TAKTUK, ELIEZER | Manager | 1001 91 ST APT 303, BAY HARBOR, FL 33154 UN |
| Name | Role | Address |
|---|---|---|
| EVANS, AARON | Member | 6413 CONGRESS AVE STE 130, BOCA RATON, FL 33487 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G24000080723 | LAKES EYE CENTER | ACTIVE | 2024-07-04 | 2029-12-31 | No data | 1200 S. ROGERS CIRCLE, STE 16, BOCA RATON, FL, 33487 |
| G23000030696 | MORAN AND MAURI EYE CENTER | ACTIVE | 2023-03-07 | 2028-12-31 | No data | 3170 N FEDERAL HWY, STE 100M, LIGHTHOUSE POINT, FL, 33064 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-18 |
| ANNUAL REPORT | 2023-04-27 |
| Florida Limited Liability | 2022-12-09 |
Date of last update: 11 Jan 2025
Sources: Florida Department of State
