| Entity Name: | MICHAEL J COLLINS JR, MD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 May 2004 (21 years ago) |
| Document Number: | P04000075033 |
| FEI/EIN Number | 201098065 |
| Address: | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 33912, US |
| Mail Address: | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 33912, US |
| ZIP code: | 33912 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1982649083 | 2006-06-20 | 2024-04-10 | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 339127151, US | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 339127151, US | |||||||||||||||||||||||
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| Phone | +1 239-936-4706 |
| Fax | 2392256775 |
Authorized person
| Name | AMY L EASON |
| Role | BILLING MANAGER |
| Phone | 2399364706 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | ME82860 |
| State | FL |
| Is Primary | No |
| Name | Role | Address |
|---|---|---|
| COLLINS MICHAEL J J | Agent | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 33912 |
| Name | Role | Address |
|---|---|---|
| COLLINS MICHAEL J | Director | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 33912 |
| Name | Role | Address |
|---|---|---|
| COLLINS MICHAEL J | President | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 33912 |
| Name | Role | Address |
|---|---|---|
| FRIEDRICHS JASON C | Secretary | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 33912 |
| Name | Role | Address |
|---|---|---|
| FRIEDRICHS JASON C | Treasurer | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 33912 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G11000015595 | COLLINS VISION | ACTIVE | 2011-02-10 | 2026-12-31 | No data | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL, 33912 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT NAME CHANGED | 2023-08-15 | COLLINS, MICHAEL J JR. | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2023-08-15 | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL 33912 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2011-03-15 | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL 33912 | No data |
| CHANGE OF MAILING ADDRESS | 2011-03-15 | 6900 INTERNATIONAL CENTER BLVD, FORT MYERS, FL 33912 | No data |
| Name | Date |
|---|---|
| AMENDED ANNUAL REPORT | 2024-06-20 |
| ANNUAL REPORT | 2024-04-08 |
| AMENDED ANNUAL REPORT | 2023-08-15 |
| ANNUAL REPORT | 2023-01-23 |
| ANNUAL REPORT | 2022-01-27 |
| ANNUAL REPORT | 2021-02-08 |
| ANNUAL REPORT | 2020-01-26 |
| ANNUAL REPORT | 2019-02-11 |
| ANNUAL REPORT | 2018-01-17 |
| ANNUAL REPORT | 2017-02-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
