| Entity Name: | OPTOMETRICA, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 19 May 2003 (22 years ago) |
| Document Number: | P03000055282 |
| FEI/EIN Number | 753115667 |
| Address: | 16876 McGregor Blvd, Suite A-102, Fort Myers, FL, 33908, US |
| Mail Address: | 6747 WILLOW LAKE CIR., FT. MYERS, FL, 33966, US |
| ZIP code: | 33908 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1174879563 | 2012-08-03 | 2012-10-01 | 6747 WILLOW LAKE CIR, FORT MYERS, FL, 339661253, US | 1571 PERIWINKLE WAY, SANIBEL, FL, 339574513, US | |||||||||||||||||||
|
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| Phone | +1 239-560-6917 |
| Fax | 2394157341 |
Authorized person
| Name | DR. PHONG MICHAEL PHAM |
| Role | PRESIDENT / OWNER |
| Phone | 2395606917 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC3502 |
| State | FL |
| Is Primary | Yes |
| Name | Role | Address |
|---|---|---|
| PHAM PHONG M | Agent | 6747 WILLOW LAKE CIR., FT. MYERS, FL, 33966 |
| Name | Role | Address |
|---|---|---|
| PHAM PHONG M | President | 6747 WILLOW LAKE CIR., FT. MYERS, FL, 33966 |
| Name | Role | Address |
|---|---|---|
| PHAM PHONG M | Director | 6747 WILLOW LAKE CIR., FT. MYERS, FL, 33966 |
| QUAN ELAINE | Director | 6747 WILLOW LAKE CIR., FT. MYERS, FL, 33966 |
| Name | Role | Address |
|---|---|---|
| QUAN ELAINE | Secretary | 6747 WILLOW LAKE CIR., FT. MYERS, FL, 33966 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G19000051946 | SANIBEL EYE CARE | ACTIVE | 2019-04-27 | 2029-12-31 | No data | 6747 WILLOW LAKE CIR, FORT MYERS, FL, 33966 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-11 | 16876 McGregor Blvd, Suite A-102, Fort Myers, FL 33908 | No data |
| CHANGE OF MAILING ADDRESS | 2007-04-22 | 16876 McGregor Blvd, Suite A-102, Fort Myers, FL 33908 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2007-04-22 | 6747 WILLOW LAKE CIR., FT. MYERS, FL 33966 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-11 |
| ANNUAL REPORT | 2023-07-06 |
| ANNUAL REPORT | 2022-01-30 |
| ANNUAL REPORT | 2021-03-13 |
| ANNUAL REPORT | 2020-06-30 |
| ANNUAL REPORT | 2019-04-08 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-04-05 |
| ANNUAL REPORT | 2016-03-27 |
| ANNUAL REPORT | 2015-04-05 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
