| Entity Name: | DR. ALAN H. SIEGEL, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 25 Aug 2000 (24 years ago) |
| Last Event: | AMENDMENT |
| Event Date Filed: | 21 Oct 2009 (15 years ago) |
| Document Number: | P00000082113 |
| FEI/EIN Number | 651037371 |
| Address: | 786 SE Hidden River Drive, PORT ST. LUCIE, FL, 34983, US |
| Mail Address: | 786 SE Hidden River Drive, PORT ST. LUCIE, FL, 34983, US |
| ZIP code: | 34983 |
| County: | St. Lucie |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| 1679757918 | 2007-12-21 | 2008-10-29 | 10692 S US HIGHWAY 1, SUITE B, PORT ST LUCIE, FL, 349526408, US | 10692 S US HIGHWAY 1, SUITE B, PORT ST LUCIE, FL, 349526408, US | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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| Phone | +1 772-335-5006 |
| Fax | 7723354672 |
Authorized person
| Name | DR. ALAN HOWARD SIEGEL |
| Role | OPTOMETRIST |
| Phone | 7723355006 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC1190 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 332H00000X - Eyewear Supplier |
| License Number | FL1190 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | VCA |
| Number | 91471 |
| Issuer | EYEMED |
| Number | 111512 |
| Issuer | BCBS |
| Number | 19745 |
| Issuer | DAVIS VISION |
| Number | 3515 |
| Issuer | MEDICARE |
| Number | AH112 |
| Issuer | CLARITY |
| Number | SI142924 |
| Issuer | GVA |
| Number | 36080 |
| Issuer | MEDICARE RR |
| Number | 410046674 |
| Issuer | NPPES |
| Number | 4066210001 |
| State | FL |
| Issuer | AETNA |
| Number | 5124007 |
| Issuer | SPECTERA |
| Number | 86030 |
| Issuer | WORKMAN'S COMP |
| Number | OP-0001190 |
| Name | Role | Address |
|---|---|---|
| SIEGEL ALAN H | Agent | 786 SE Hidden River Drive, PORT ST. LUCIE, FL, 34983 |
| Name | Role | Address |
|---|---|---|
| SIEGEL ALAN H | President | 786 SE Hidden River Drive, PORT ST. LUCIE, FL, 34983 |
| Name | Role | Address |
|---|---|---|
| SIEGEL ALAN H | Secretary | 786 SE Hidden River Drive, PORT ST. LUCIE, FL, 34983 |
| Name | Role | Address |
|---|---|---|
| SIEGEL ALAN H | Director | 786 SE Hidden River Drive, PORT ST. LUCIE, FL, 34983 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G21000011367 | SOUTHPORT PROFESSIONAL CENTER | ACTIVE | 2021-01-23 | 2026-12-31 | No data | 786 SE HIDDEN RIVER DRIVE, PORT ST LUCIE, FL, 34952 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-04-26 | 786 SE Hidden River Drive, PORT ST. LUCIE, FL 34983 | No data |
| CHANGE OF MAILING ADDRESS | 2018-04-26 | 786 SE Hidden River Drive, PORT ST. LUCIE, FL 34983 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2018-04-26 | 786 SE Hidden River Drive, PORT ST. LUCIE, FL 34983 | No data |
| AMENDMENT | 2009-10-21 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-18 |
| ANNUAL REPORT | 2023-04-26 |
| ANNUAL REPORT | 2022-03-30 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-04-24 |
| ANNUAL REPORT | 2018-04-26 |
| ANNUAL REPORT | 2017-03-02 |
| ANNUAL REPORT | 2016-04-25 |
| ANNUAL REPORT | 2015-02-24 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
