| Entity Name: | SEVIGNY & ASSOCIATES EYE CARE PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 06 Mar 2009 (16 years ago) |
| Document Number: | P09000021144 |
| FEI/EIN Number | 943472247 |
| Address: | 21 S Lake Ave, Avon Park, FL, 33825, US |
| Mail Address: | 21 S Lake Ave, Avon Park, FL, 33825, US |
| ZIP code: | 33825 |
| County: | Highlands |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1649427543 | 2008-08-21 | 2017-11-02 | 735 N 6TH AVE, WAUCHULA, FL, 338732002, US | 735 N 6TH AVE, WAUCHULA, FL, 338732002, US | |||||||||||||||||||||||||
|
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| Phone | +1 863-773-3322 |
| Fax | 8637736458 |
Authorized person
| Name | DR. MARK D. SEVIGNY |
| Role | OWNER/DOCTOR |
| Phone | 8637733322 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | 152W00000X |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 002372600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| DONALDSON DEVON | Agent | 120 SOUTH ANOKA AVE, AVON PARK, FL, 33825 |
| Name | Role | Address |
|---|---|---|
| SEVIGNY MARK | President | 531 LAKE LOTELA DR., AVON PARK, FL, 33825 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2018-03-14 | 21 S Lake Ave, Avon Park, FL 33825 | No data |
| CHANGE OF MAILING ADDRESS | 2018-03-14 | 21 S Lake Ave, Avon Park, FL 33825 | No data |
| Document Number | Status | Case Number | Name of Court | Date of Entry | Expiration Date | Amount Due | Plaintiff |
|---|---|---|---|---|---|---|---|
| J11000782917 | TERMINATED | 1000000241507 | HARDEE | 2011-11-21 | 2021-11-30 | $ 4,877.18 | STATE OF FLORIDA, DEPARTMENT OF REVENUE, LAKELAND SERVICE CENTER, 115 S MISSOURI AVE STE 202, LAKELAND FL338154644 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-20 |
| ANNUAL REPORT | 2023-04-06 |
| ANNUAL REPORT | 2022-03-21 |
| ANNUAL REPORT | 2021-04-01 |
| ANNUAL REPORT | 2020-01-15 |
| ANNUAL REPORT | 2019-02-13 |
| ANNUAL REPORT | 2018-03-14 |
| ANNUAL REPORT | 2017-03-17 |
| ANNUAL REPORT | 2016-03-28 |
| ANNUAL REPORT | 2015-02-15 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
