| Entity Name: | ADVANCED EYE CARE OF HIALEAH, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 22 Nov 2004 (20 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P04000159336 |
| FEI/EIN Number | 201935608 |
| Address: | 5952 WEST 16TH AVE, HIALEAH, FL, 33012 |
| Mail Address: | 5952 WEST 16TH AVE, HIALEAH, FL, 33012 |
| ZIP code: | 33012 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1023111036 | 2006-09-06 | 2011-08-16 | 5952 W 16TH AVE, HIALEAH, FL, 330126814, US | 5952 W 16TH AVE, HIALEAH, FL, 330126814, US | |||||||||||||||||||||||||
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| Phone | +1 305-556-6946 |
| Fax | 3058250845 |
Authorized person
| Name | DR. KERI MARIE POMELLA |
| Role | PRESIDENT |
| Phone | 3055566946 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | 3040 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 621004000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| POMELLA KERI M | Agent | 3552 MAGELLAN CIRCLE, AVENTURA, FL, 33180 |
| Name | Role | Address |
|---|---|---|
| POMELLA KERI M | President | 3552 MAGELLAN CIRCLE #124, AVENTURA, FL, 33180 |
| Name | Role | Address |
|---|---|---|
| PELTZER BRADLEY A | Vice President | 18131 NW 66th Ct, MIAMI Lakes, FL, 33015 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2009-04-15 | 5952 WEST 16TH AVE, HIALEAH, FL 33012 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-05-01 | 5952 WEST 16TH AVE, HIALEAH, FL 33012 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-04-15 |
| ANNUAL REPORT | 2014-04-01 |
| ANNUAL REPORT | 2013-04-04 |
| ANNUAL REPORT | 2012-04-11 |
| ANNUAL REPORT | 2011-04-14 |
| ANNUAL REPORT | 2010-03-31 |
| ANNUAL REPORT | 2009-04-15 |
| ANNUAL REPORT | 2008-04-18 |
| ANNUAL REPORT | 2007-04-23 |
| ANNUAL REPORT | 2006-05-01 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
