| Entity Name: | ROBERT L. PHILLIPS, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 May 2002 (23 years ago) |
| Document Number: | P02000055716 |
| FEI/EIN Number | 331006452 |
| Address: | 2173 SURF SIDE DRIVE, FERNANDINA BEACH, FL, 32034, US |
| Mail Address: | 2173 SURF SIDE DRIVE, FERNANDINA BEACH, FL, 32034, US |
| ZIP code: | 32034 |
| County: | Nassau |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1053581967 | 2008-03-06 | 2018-04-09 | 1580 BLANDING BLVD, JACKSONVILLE, FL, 322101834, US | 1580 BLANDING BLVD, JACKSONVILLE, FL, 322101834, US | |||||||||||||||||||||||||||||||
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| Phone | +1 904-387-0025 |
| Fax | 9043870969 |
Authorized person
| Name | ROBERT L. PHILLIPS |
| Role | OWNER |
| Phone | 9043870025 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC930 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 084322900 |
| State | FL |
| Issuer | MEDICAID |
| Number | 084322901 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PHILLIPS ROBERT L | Agent | 2173 SURF SIDE DRIVE, FERNANDINA BEACH, FL, 32034 |
| Name | Role | Address |
|---|---|---|
| PHILLIPS ROBERT L | Director | 2173 SURF SIDE DRIVE, FERNANDINA BEACH, FL, 32034 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-02-05 | 2173 SURF SIDE DRIVE, FERNANDINA BEACH, FL 32034 | No data |
| CHANGE OF MAILING ADDRESS | 2024-02-05 | 2173 SURF SIDE DRIVE, FERNANDINA BEACH, FL 32034 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-02-05 | 2173 SURF SIDE DRIVE, FERNANDINA BEACH, FL 32034 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-01-29 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-28 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-03-25 |
| ANNUAL REPORT | 2018-03-03 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-24 |
| ANNUAL REPORT | 2015-01-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
