| Entity Name: | FLORIDA'S VISION QUEST, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Non-Profit |
| Status: | Inactive |
| Date Filed: | 06 Sep 1994 (30 years ago) |
| Document Number: | N94000004361 |
| FEI/EIN Number | 593269114 |
| Address: | 177 NORTH INDUSTRIAL DRIVE, ORANGE CITY, FL, 32763, US |
| Mail Address: | 177 NORTH INDUSTRIAL DRIVE, ORANGE CITY, FL, 32763, US |
| ZIP code: | 32763 |
| County: | Volusia |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336584176 | 2013-05-07 | 2016-06-06 | 167 N INDUSTRIAL DR, ORANGE CITY, FL, 327637414, US | 167 N INDUSTRIAL DR, ORANGE CITY, FL, 327637414, US | |||||||||||||||||||||||||
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| Phone | +1 386-917-1001 |
| Fax | 3869171008 |
Authorized person
| Name | MS. KELLY LYNN HAYNES |
| Role | EXECUTIVE DIRECTOR |
| Phone | 3869171001 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC1293 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 008735000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| Jeppesen Nancy L | Agent | 177 N INDUSTRIAL DRIVE, ORANGE CITY, FL, 32763 |
| Name | Role | Address |
|---|---|---|
| JEPPESEN NANCY | Chief Executive Officer | 177 NORTH INDUSTRIAL DRIVE, ORANGE CITY, FL, 32763 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| VOLUNTARY DISSOLUTION | 2023-06-30 | No data | No data |
| AMENDMENT AND NAME CHANGE | 2007-05-11 | FLORIDA'S VISION QUEST, INC. | No data |
| NAME CHANGE AMENDMENT | 1997-04-17 | JEPPESEN VISIONQUEST, INC. | No data |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
