| Entity Name: | BREVARD EYE ASSOCIATES, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 27 Jul 1990 (35 years ago) |
| Date of dissolution: | 11 Oct 1991 (33 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 11 Oct 1991 (33 years ago) |
| Document Number: | L89538 |
| FEI/EIN Number | 00-0000000 |
| Address: | 1355 S. HICKORY STREET, MELBOURNE, FL 32901 |
| Mail Address: | 1355 S. HICKORY STREET, MELBOURNE, FL 32901 |
| ZIP code: | 32901 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1568688133 | 2007-04-18 | 2023-03-07 | 1264 US HIGHWAY 1, ROCKLEDGE, FL, 329552746, US | 1264 US HIGHWAY 1, ROCKLEDGE, FL, 329552746, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 321-636-2722 |
| Fax | 3216324109 |
Authorized person
| Name | DR. BRIAN CARLTON LYNN JR. |
| Role | OWNER |
| Phone | 3216362722 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | ME18207 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 00412 |
| Issuer | CAQH |
| Number | 10714580 |
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 05294 |
| Issuer | CIGNA |
| Number | 1739227001 |
| Issuer | AETNA |
| Number | 5013483 |
| Name | Role | Address |
|---|---|---|
| BOYD, JOEL E. | Agent | 100 RIALTO PLACE, SUITE 800, MELBOURNE, FL 32901 |
| Name | Role | Address |
|---|---|---|
| BOYD, JOEL E. | Director | 100 RIALTO PLACE #800, MELBOURNE, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1991-10-11 | No data | No data |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
