| Entity Name: | SUNRISE OPHTHALMOLOGY ASC, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Foreign Limited Liability Co. |
| Status: | Inactive |
| Date Filed: | 22 Mar 2001 (24 years ago) |
| Date of dissolution: | 25 Sep 2015 (9 years ago) |
| Last Event: | REVOKED FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2015 (9 years ago) |
| Document Number: | M01000000628 |
| FEI/EIN Number | 621848874 |
| Address: | 7805 SW 6 COURT, PLANTATION, FL, 33324 |
| Mail Address: | 7805 SW 6 COURT, PLANTATION, FL, 33324 |
| ZIP code: | 33324 |
| County: | Broward |
| Place of Formation: | TENNESSEE |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1215900246 | 2006-02-09 | 2009-05-06 | 3737 N PINE ISLAND RD, SUNRISE, FL, 333516528, US | 3737 N PINE ISLAND RD, SUNRISE, FL, 333516528, US | |||||||||||||||||||||||||
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| Phone | +1 954-572-5888 |
| Fax | 9545725994 |
Authorized person
| Name | MS. BILLIE A PAYNE |
| Role | PRESIDENT |
| Phone | 6156651283 |
Taxonomy
| Taxonomy Code | 261QA1903X - Ambulatory Surgical Clinic/Center |
| License Number | 750 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 075162600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WEINBERG STEVEN AESQ. | Agent | FRANK, WEINBERG & BLACK, P.L., PLANTATION, FL, 33324 |
| Name | Role |
|---|---|
| PHYSICIAN HOLDING CORP. | Managing Member |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REVOKED FOR ANNUAL REPORT | 2015-09-25 | No data | No data |
| LC DISSOCIATION MEM | 2014-07-16 | No data | No data |
| LC STMNT OF RA/RO CHG | 2014-06-09 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2014-06-09 | WEINBERG, STEVEN A, ESQ. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-06-09 | FRANK, WEINBERG & BLACK, P.L., 7805 SW 6 COURT, PLANTATION, FL 33324 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2014-06-09 | 7805 SW 6 COURT, PLANTATION, FL 33324 | No data |
| CHANGE OF MAILING ADDRESS | 2014-06-09 | 7805 SW 6 COURT, PLANTATION, FL 33324 | No data |
| LC NAME CHANGE | 2014-01-17 | SUNRISE OPHTHALMOLOGY ASC, LLC | No data |
| NAME CHANGE AMENDMENT | 2001-10-26 | THE SUNRISE OPHTHALMOLOGY ASC, LLC | No data |
| Name | Date |
|---|---|
| CORLCDSMEM | 2014-07-16 |
| CORLCRACHG | 2014-06-09 |
| ANNUAL REPORT | 2014-03-25 |
| LC Name Change | 2014-01-17 |
| ANNUAL REPORT | 2013-04-16 |
| ANNUAL REPORT | 2012-04-12 |
| ANNUAL REPORT | 2011-02-15 |
| ANNUAL REPORT | 2010-02-18 |
| ANNUAL REPORT | 2009-04-09 |
| ANNUAL REPORT | 2008-05-02 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
