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  5. AFFILIATED EYE SPECIALISTS, P.A.

AFFILIATED EYE SPECIALISTS, P.A.

Company Details

Entity Name: AFFILIATED EYE SPECIALISTS, P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 16 Jul 1990 (35 years ago)
Last Event: AMENDMENT
Event Date Filed: 28 Feb 2017 (8 years ago)
Document Number: L87690
FEI/EIN Number 59-3021959
Address: 331 North Maitland Avenue, Suite B-2, Maitland, FL 32751
Mail Address: 331 North Maitland Avenue, Suite B-2, Maitland, FL 32751
ZIP code: 32751
County: Orange
Place of Formation: FLORIDA

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1396897591 2007-01-17 2011-04-14 331 N MAITLAND AVE, STE B2, MAITLAND, FL, 327514753, US 331 N MAITLAND AVE, STE B2, MAITLAND, FL, 327514753, US

Contacts
Phone +1 407-740-0331
Fax 4075392747

Authorized person
Name MARC FRANKLIN SCHWARTZ
Role PRESIDENT
Phone 4077400331

Taxonomy
Taxonomy Code 174400000X - Specialist
License Number MD0047068
State FL
Is Primary Yes

Other Provider Identifiers
Issuer CIGNA
Number 1226932007
Issuer BLUE CROSS BLUE SHIELD
Number 72948
Issuer RAILROAD MEDICARE
Number CA9128
Issuer AETNA
Number 2001142
Issuer MEDICARE PTAN
Number 72948
State FL
Issuer MEDICAID
Number 039944200
State FL
Issuer GHI
Number 13551
Issuer BLUE CROSS BLUE SHIELD IND
Number 96809
State FL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2018 593021959 2019-02-22 AFFILIATED EYE SPECIALISTS, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N MAITLAND AVE, MAITLAND, FL, 32751
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2017 593021959 2018-07-07 AFFILIATED EYE SPECIALISTS, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N MAITLAND AVE, MAITLAND, FL, 32751
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2016 593021959 2018-07-07 AFFILIATED EYE SPECIALISTS, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N MAITLAND AVE, MAITLAND, FL, 32751
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2016 593021959 2017-10-15 AFFILIATED EYE SPECIALISTS, P.A. 8
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N MAITLAND AVE, MAITLAND, FL, 32751
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2015 593021959 2016-08-26 AFFILIATED EYE SPECIALISTS, P.A. 8
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N MAITLAND AVE, MAITLAND, FL, 32751
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2014 593021959 2015-05-21 AFFILIATED EYE SPECIALISTS, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N. MAITLAND AVENUE, B-2, MAITLAND, FL, 32751
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2013 593021959 2014-05-23 AFFILIATED EYE SPECIALISTS, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N. MAITLAND AVENUE, B-2, MAITLAND, FL, 32751
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2012 593021959 2013-06-23 AFFILIATED EYE SPECIALISTS, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N. MAITLAND AVENUE, B-2, MAITLAND, FL, 32751

Signature of
Role Plan administrator
Date 2013-06-23
Name of individual signing CRAIG DIVITA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2011 593021959 2012-07-01 AFFILIATED EYE SPECIALISTS, P.A. 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N. MAITLAND AVENUE, B-2, MAITLAND, FL, 32751

Plan administrator’s name and address
Administrator’s EIN 593021959
Plan administrator’s name AFFILIATED EYE SPECIALISTS, P.A.
Plan administrator’s address 311 N. MAITLAND AVENUE, B-2, MAITLAND, FL, 32751
Administrator’s telephone number 4077400331

Signature of
Role Plan administrator
Date 2012-07-01
Name of individual signing CRAIG DIVITA
Valid signature Filed with authorized/valid electronic signature
AFFILIATED EYE SPECIALISTS, P.A. RETIREMENT & SAVINGS PLAN 2010 593021959 2011-10-08 AFFILIATED EYE SPECIALISTS, P.A. 7
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1997-01-01
Business code 621111
Sponsor’s telephone number 4077400331
Plan sponsor’s address 311 N. MAITLAND AVENUE, B-2, MAITLAND, FL, 32751

Plan administrator’s name and address
Administrator’s EIN 593021959
Plan administrator’s name AFFILIATED EYE SPECIALISTS, P.A.
Plan administrator’s address 311 N. MAITLAND AVENUE, B-2, MAITLAND, FL, 32751
Administrator’s telephone number 4077400331

Signature of
Role Plan administrator
Date 2011-10-08
Name of individual signing CRAIG DIVITA
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
AZIZ, ANDY A. Agent 1380 CAMDEN CT, Suite B2, CLERMONT, FL 34711-4610

President

Name Role Address
AZIZ, ANDY A. President 331 North Maitland Avenue, Suite B-2 Maitland, FL 32751

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2023-01-06 331 North Maitland Avenue, Suite B-2, Maitland, FL 32751 No data
CHANGE OF MAILING ADDRESS 2023-01-06 331 North Maitland Avenue, Suite B-2, Maitland, FL 32751 No data
REGISTERED AGENT ADDRESS CHANGED 2023-01-06 1380 CAMDEN CT, Suite B2, CLERMONT, FL 34711-4610 No data
AMENDMENT 2017-02-28 No data No data
REGISTERED AGENT NAME CHANGED 2017-02-28 AZIZ, ANDY A. No data
NAME CHANGE AMENDMENT 2006-11-13 AFFILIATED EYE SPECIALISTS, P.A. No data

Documents

Name Date
ANNUAL REPORT 2024-01-09
ANNUAL REPORT 2023-01-06
ANNUAL REPORT 2022-01-23
ANNUAL REPORT 2021-01-31
ANNUAL REPORT 2020-01-18
ANNUAL REPORT 2019-02-11
ANNUAL REPORT 2018-01-17
Amendment 2017-02-28
ANNUAL REPORT 2017-01-14
ANNUAL REPORT 2016-03-03

Related by officers

No related officers

Related by address

No related companies by address

Date of last update: 03 Feb 2025

Sources: Florida Department of State

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