| Entity Name: | A. L. HARRELL, III, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 16 Oct 1989 (35 years ago) |
| Document Number: | L23180 |
| FEI/EIN Number | 65-0149252 |
| Address: | 14780 Horseshoe Trace, Wellington, FL 33414 |
| Mail Address: | 14780 Horseshoe Trace, Wellington, FL 33414 |
| ZIP code: | 33414 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1083914808 | 2010-10-26 | 2011-05-10 | 11924 W FOREST HILL BLVD, 31, WELLINGTON, FL, 334146256, US | 11924 W FOREST HILL BLVD, 31, WELLINGTON, FL, 334146256, US | |||||||||||||||||||||||||||||||
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| Phone | +1 561-798-8282 |
| Fax | 5617982840 |
Authorized person
| Name | DR. ALBERT L. HARRELL III |
| Role | PRESIDENT |
| Phone | 5617988282 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OP 1746 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DMERC |
| Number | 0776020002 |
| State | FL |
| Issuer | MEDICAID |
| Number | 078294701 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HARRELL, III, ALBERT L., O.D. | Agent | 14780 Horseshoe Trace, Wellington, FL 33414 |
| Name | Role | Address |
|---|---|---|
| Harrell, Albert L, III | Director | 14780 Horseshoe Trace, Wellington, FL 33414 |
| Name | Role | Address |
|---|---|---|
| Harrell, Albert L, III | President | 14780 Horseshoe Trace, Wellington, FL 33414 |
| Name | Role | Address |
|---|---|---|
| Harrell, Diana M. | Vice President | 14780 Horseshoe Trace, Wellington, FL 33414 |
| Name | Role | Address |
|---|---|---|
| Harrell, Diana M. | Treasurer | 14780 Horseshoe Trace, Wellington, FL 33414 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2019-05-01 | 14780 Horseshoe Trace, Wellington, FL 33414 | No data |
| CHANGE OF MAILING ADDRESS | 2019-05-01 | 14780 Horseshoe Trace, Wellington, FL 33414 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2019-05-01 | 14780 Horseshoe Trace, Wellington, FL 33414 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-04-23 | HARRELL, III, ALBERT L., O.D. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-06 |
| ANNUAL REPORT | 2023-04-24 |
| ANNUAL REPORT | 2022-04-01 |
| ANNUAL REPORT | 2021-04-08 |
| ANNUAL REPORT | 2020-05-21 |
| ANNUAL REPORT | 2019-05-01 |
| ANNUAL REPORT | 2018-04-12 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-04-23 |
| ANNUAL REPORT | 2015-04-24 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
