| Entity Name: | WILLIAM A. OLIVOS, OD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 28 Dec 2001 (23 years ago) |
| Document Number: | P01000122019 |
| FEI/EIN Number | 800027780 |
| Address: | 460 NW Dover Ct, PORT ST. LUCIE, FL, 34983, US |
| Mail Address: | 460 NW Dover Ct, 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 | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1962075358 | 2021-07-22 | 2021-07-23 | 2710 SW PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL, 349532849, US | 2710 SW PORT ST LUCIE BLVD, PORT SAINT LUCIE, FL, 349532849, US | |||||||||||||||||||||
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| Phone | +1 772-460-8487 |
| Fax | 7724600225 |
Authorized person
| Name | DR. WILLIAM A OLIVOS |
| Role | OWNER |
| Phone | 7724608487 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002946001 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| OLIVOS WILLIAM A | Agent | 460 NW Dover Ct, PORT ST. LUCIE, FL, 34983 |
| Name | Role | Address |
|---|---|---|
| OLIVOS WILLIAM A | Director | 460 NW Dover Ct, PORT ST. LUCIE, FL, 34983 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G05090900235 | ADVANCED EYE CARE CENTER | ACTIVE | 2005-03-31 | 2025-12-31 | No data | 4976 SOUTH 25TH STREET, FT. PIERCE, FL, 34981 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2015-04-06 | 460 NW Dover Ct, PORT ST. LUCIE, FL 34983 | No data |
| CHANGE OF MAILING ADDRESS | 2015-04-06 | 460 NW Dover Ct, PORT ST. LUCIE, FL 34983 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2015-04-06 | 460 NW Dover Ct, PORT ST. LUCIE, FL 34983 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-18 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-03-06 |
| ANNUAL REPORT | 2021-04-10 |
| ANNUAL REPORT | 2020-03-16 |
| ANNUAL REPORT | 2019-04-15 |
| ANNUAL REPORT | 2018-03-13 |
| ANNUAL REPORT | 2017-04-11 |
| ANNUAL REPORT | 2016-04-12 |
| ANNUAL REPORT | 2015-04-06 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
