| Entity Name: | BLIND AND LOW VISION REHABILITATION SERVICES & CONSULTING, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 21 Dec 2004 (20 years ago) |
| Date of dissolution: | 14 Sep 2007 (17 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 14 Sep 2007 (17 years ago) |
| Document Number: | P04000170383 |
| FEI/EIN Number | 770653810 |
| Address: | 2625 SW 75TH ST., 1301, GAINESVILLE, FL, 32607, US |
| Mail Address: | 2625 SW 75TH ST., 1301, GAINESVILLE, FL, 32607, US |
| ZIP code: | 32607 |
| County: | Alachua |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1548303019 | 2007-02-15 | 2020-08-22 | 2625 SW 75TH ST, 1301, GAINESVILLE, FL, 326076636, US | 2625 SW 75TH ST, 1301, GAINESVILLE, FL, 326076636, US | |||||||||||||||||||||||
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| Phone | +1 352-246-9578 |
Authorized person
| Name | MR. ERIC EUGENE HICKS |
| Role | PRESIDENT |
| Phone | 3522469578 |
Taxonomy
| Taxonomy Code | 225X00000X - Occupational Therapist |
| License Number | OT11044 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 8908044 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| HICKS ERIC E | Agent | 2625 SW 75TH ST., GAINESVILLE, FL, 32607 |
| Name | Role | Address |
|---|---|---|
| HICKS ERIC E | President | 2625 SW 75TH ST., GAINESVILLE, FL, 32607 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2007-09-14 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2006-03-08 | 2625 SW 75TH ST., 1301, GAINESVILLE, FL 32607 | No data |
| CHANGE OF MAILING ADDRESS | 2006-03-08 | 2625 SW 75TH ST., 1301, GAINESVILLE, FL 32607 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2006-03-08 | 2625 SW 75TH ST., 1301, GAINESVILLE, FL 32607 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2006-03-08 |
| ANNUAL REPORT | 2005-03-12 |
| Domestic Profit | 2004-12-21 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
