| Entity Name: | ISABEL M CARVAJAL, OD, PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 24 Aug 2007 (17 years ago) |
| Document Number: | P07000095071 |
| FEI/EIN Number | 260772733 |
| Address: | 33 E Camino Real, Boca Raton, FL, 33432, US |
| Mail Address: | 33 E Camino Real, Boca Raton, FL, 33432, US |
| ZIP code: | 33432 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649409319 | 2009-07-02 | 2010-08-05 | 5140 STAGECOACH DR, COCONUT CREEK, FL, 330732242, US | 11605 PINES BLVD, PEMBROKE PINES, FL, 330264109, US | |||||||||||||||||||||||||||||||||||||||
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| Phone | +1 954-438-2428 |
| Fax | 9544382429 |
| Fax | 9544382450 |
Authorized person
| Name | ISABEL M CARVAJAL |
| Role | PRESIDENT OPTOMETRIST |
| Phone | 9548734130 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC4213 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | DAVIS VISION |
| Number | 58551 |
| State | FL |
| Issuer | EYEMED |
| Number | FL4213 |
| State | FL |
| Issuer | MEDICAID |
| Number | PENDING |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CARVAJAL ISABEL M | Agent | 33 E Camino Real, Boca Raton, FL, 33432 |
| Name | Role | Address |
|---|---|---|
| CARVAJAL ISABEL M | President | 33 E Camino Real, Boca Raton, FL, 33432 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-03-07 | 33 E Camino Real, 600, Boca Raton, FL 33432 | No data |
| CHANGE OF MAILING ADDRESS | 2024-03-07 | 33 E Camino Real, 600, Boca Raton, FL 33432 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-07 | 33 E Camino Real, 600, Boca Raton, FL 33432 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-07 |
| ANNUAL REPORT | 2023-03-28 |
| ANNUAL REPORT | 2022-03-08 |
| ANNUAL REPORT | 2021-03-16 |
| ANNUAL REPORT | 2020-04-02 |
| ANNUAL REPORT | 2019-04-12 |
| ANNUAL REPORT | 2018-02-20 |
| ANNUAL REPORT | 2017-03-07 |
| ANNUAL REPORT | 2016-02-10 |
| ANNUAL REPORT | 2015-04-26 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
