| Entity Name: | MASTERCRAFT OPTICAL GALLERY, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Apr 2003 (22 years ago) |
| Document Number: | P03000043194 |
| FEI/EIN Number | 030516355 |
| Address: | 520 SOUTH PARROTT AVE., OKEECHOBEE, FL, 34974 |
| Mail Address: | 520 SOUTH PARROTT AVE., OKEECHOBEE, FL, 34974 |
| ZIP code: | 34974 |
| County: | Okeechobee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407954399 | 2006-09-21 | 2008-09-16 | 520 S PARROTT AVE, OKEECHOBEE, FL, 349744345, US | 520 S PARROTT AVE, OKEECHOBEE, FL, 349744345, US | |||||||||||||||||||||||||||||||
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| Phone | +1 863-763-4334 |
| Fax | 8637633226 |
Authorized person
| Name | GWENDOLYN J KING |
| Role | OWNER |
| Phone | 8637634334 |
Taxonomy
| Taxonomy Code | 332H00000X - Eyewear Supplier |
| License Number | D02342 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | D7841 |
| State | FL |
| Issuer | MEDICAID |
| Number | 086132400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KING GWENDOLYN J | Agent | 520 SOUTH PARROTT AVE., OKEECHOBEE, FL, 34974 |
| Name | Role | Address |
|---|---|---|
| KING GWENDOLYN J | Director | 520 SOUTH PARROTT AVE., OKEECHOBEE, FL, 34974 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2010-04-15 | KING, GWENDOLYN J | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-20 |
| ANNUAL REPORT | 2023-03-15 |
| ANNUAL REPORT | 2022-04-07 |
| ANNUAL REPORT | 2021-04-04 |
| ANNUAL REPORT | 2020-04-23 |
| ANNUAL REPORT | 2019-03-19 |
| ANNUAL REPORT | 2018-02-27 |
| ANNUAL REPORT | 2017-03-17 |
| ANNUAL REPORT | 2016-04-15 |
| ANNUAL REPORT | 2015-04-07 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
