| Entity Name: | LOW VISION CENTER OF NORTHEAST FLORIDA, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 14 May 2004 (21 years ago) |
| Date of dissolution: | 26 Sep 2014 (10 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 26 Sep 2014 (10 years ago) |
| Document Number: | N04000004873 |
| FEI/EIN Number | 201215132 |
| Address: | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32204 |
| Mail Address: | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32204 |
| ZIP code: | 32204 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1235329848 | 2007-07-30 | 2008-06-25 | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL, 322044710, US | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL, 322044710, US | |||||||||||||||||||||||||||||||||||
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| Phone | +1 904-389-9989 |
| Fax | 9043891060 |
Authorized person
| Name | DR. TIFFANY E OWENS |
| Role | CLINICAL DIRECTOR |
| Phone | 9043899989 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC4045 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | RAILROAD MEDICARE |
| Number | DE3862 |
| Issuer | MEDICAID |
| Number | 621075900 |
| State | FL |
| Issuer | BCBS |
| Number | 28569 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SEELY FRED L | Agent | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32204 |
| Name | Role | Address |
|---|---|---|
| KINNE FRANCES B | Director | 4032 MISSION HILLS CIRCLE WEST, JACKSONVILLE, FL, 32205 |
| KNAUER DEBORAH E | Director | 1900 RIVERSIDE AVE SUITE 115, JACKSONVILLE, FL, 32204 |
| KNAUER W.J. I | Director | 2535 RIVERSIDE AVE, JACKSONVILLE, FL, 32204 |
| Seely Fred L | Director | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32204 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2008-01-21 | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL 32204 | No data |
| CHANGE OF MAILING ADDRESS | 2008-01-21 | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL 32204 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-01-21 | 2519 RIVERSIDE AVENUE, JACKSONVILLE, FL 32204 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2013-04-03 |
| ANNUAL REPORT | 2012-02-16 |
| ANNUAL REPORT | 2011-03-25 |
| ANNUAL REPORT | 2010-03-09 |
| ANNUAL REPORT | 2009-04-30 |
| ANNUAL REPORT | 2008-01-21 |
| ANNUAL REPORT | 2007-03-07 |
| ANNUAL REPORT | 2006-09-01 |
| ANNUAL REPORT | 2005-08-31 |
| Domestic Non-Profit | 2004-05-14 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
