| Entity Name: | DEBRA A. SHIM, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 19 Mar 2001 (24 years ago) |
| Document Number: | P01000028256 |
| FEI/EIN Number | 65-1092011 |
| Address: | 451 UNIVERSITY BLVD, STE 102, JUPITER, FL 33458-2862 |
| Mail Address: | 451 UNIVERSITY BLVD, STE 102, JUPITER, FL 33458-2862 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1134455736 | 2009-11-02 | 2010-02-23 | 451 UNIVERSITY BLVD, SUITE 102, JUPITER, FL, 334583102, US | 451 UNIVERSITY BLVD, SUITE 102, JUPITER, FL, 334583102, US | |||||||||||||||||||||||
|
|||||||||||||||||||||||||||
| Phone | +1 561-625-4380 |
| Fax | 5616253920 |
Authorized person
| Name | DEBRA A SHIM |
| Role | OPTOMETRIST/OWNER |
| Phone | 5616254380 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC 3312 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICARE PTAN |
| Number | CL589A |
| Name | Role | Address |
|---|---|---|
| SICILIANO, THOMAS V | Agent | 980 N FEDERAL HWY SUITE 440, BOCA RATON, FL 33432 |
| Name | Role | Address |
|---|---|---|
| SHIM, DEBRA A | DR. | 451 UNIVERSITY BLVD, STE 102, JUPITER, FL 33458 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G14000113704 | VISUALEYES OF THE PALM BEACHES | ACTIVE | 2014-11-11 | 2029-12-31 | No data | 451 UNIVERSITY BLVD, SUITE 102, JUPITER, FL, 33458 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2009-09-18 | 451 UNIVERSITY BLVD, STE 102, JUPITER, FL 33458-2862 | No data |
| CHANGE OF MAILING ADDRESS | 2009-09-18 | 451 UNIVERSITY BLVD, STE 102, JUPITER, FL 33458-2862 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-12 |
| ANNUAL REPORT | 2023-04-09 |
| ANNUAL REPORT | 2022-01-25 |
| ANNUAL REPORT | 2021-07-27 |
| ANNUAL REPORT | 2020-05-20 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-03-30 |
| ANNUAL REPORT | 2017-02-09 |
| ANNUAL REPORT | 2016-03-25 |
| ANNUAL REPORT | 2015-04-21 |
Date of last update: 31 Jan 2025
Sources: Florida Department of State
