| Entity Name: | GREGORY W. CHIN, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 18 Sep 2000 (24 years ago) |
| Document Number: | P00000087983 |
| FEI/EIN Number | 651040198 |
| Address: | 11423 SW 40TH ST, MIAMI, FL, 33165, US |
| Mail Address: | 11423 SW 40TH ST, MIAMI, FL, 33165, US |
| ZIP code: | 33165 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124200894 | 2007-12-04 | 2008-09-23 | 11455 SW 40TH ST, MIAMI, FL, 331653311, US | 11455 SW 40TH ST, MIAMI, FL, 331653311, US | |||||||||||||||||||||||||
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| Phone | +1 305-551-6200 |
| Fax | 3055513696 |
Authorized person
| Name | DR. GREGORY WAYNE CHIN |
| Role | OPTOMETRIST/PRESIDENT |
| Phone | 3055516200 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC 3437 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 620687500 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHIN GREGORY W | Agent | 11423 SW 40TH ST, MIAMI, FL, 33165 |
| Name | Role | Address |
|---|---|---|
| CHIN GREGORY W | Director | 11423 SW 40TH ST, MIAMI, FL, 33165 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G10000063960 | DOCTORS OF VISION | ACTIVE | 2010-07-12 | 2025-12-31 | No data | 10151 SW 118TH TER, MIAMI, FL, 33176 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2016-01-28 | 11423 SW 40TH ST, MIAMI, FL 33165 | No data |
| CHANGE OF MAILING ADDRESS | 2016-01-28 | 11423 SW 40TH ST, MIAMI, FL 33165 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-01-28 | 11423 SW 40TH ST, MIAMI, FL 33165 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-06-16 | CHIN, GREGORY WOD | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-16 |
| ANNUAL REPORT | 2024-03-10 |
| ANNUAL REPORT | 2023-02-25 |
| ANNUAL REPORT | 2022-04-11 |
| ANNUAL REPORT | 2021-01-31 |
| ANNUAL REPORT | 2020-05-04 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-01-22 |
| ANNUAL REPORT | 2017-04-09 |
| ANNUAL REPORT | 2016-01-28 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
