| Entity Name: | CW VISION OPTICAL, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 16 Mar 2009 (16 years ago) |
| Date of dissolution: | 23 Sep 2011 (13 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2011 (13 years ago) |
| Document Number: | P09000023986 |
| FEI/EIN Number | 264469942 |
| Mail Address: | 2920 BAILEY ROAD, FERNANDINA BEACH, FL, 32034 |
| Address: | 463646 SR 200, YULEE, FL, 32090-7 |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1124260401 | 2009-04-01 | 2009-09-22 | 463646 SR 200 A1A, SUITE 12, YULEE, FL, 32097, US | 463646 S.R. 200 A1A, SUITE 12, YULEE, FL, 320970303, US | |||||||||||||||||||||||||
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| Phone | +1 904-849-7431 |
| Fax | 9048497436 |
Authorized person
| Name | DR. JAMES D. CHAMBERLAIN |
| Role | PRESIDENT |
| Phone | 9048497431 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC0001462 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 620513501 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| POECHMANN PAIGE P | Agent | 303 CENTRE STREET, FERNANDINA BEACH, FL, 32034 |
| Name | Role | Address |
|---|---|---|
| CHAMBERLAIN JAMES D | President | 463646 SR 200, YULEE, FL, 32097 |
| Name | Role | Address |
|---|---|---|
| ALLEN PHILLIP | Vice President | 463646 SR 200, YULEE, FL, 32097 |
| Name | Role | Address |
|---|---|---|
| HAMPTON MATTHEW | Secretary | 463646 SR 200, YULEE, FL, 32097 |
| Name | Role | Address |
|---|---|---|
| HAMPTON MATTHEW | Treasurer | 463646 SR 200, YULEE, FL, 32097 |
| Name | Role | Address |
|---|---|---|
| TUSO MARK | Director | 463646 SR 200, YULEE, FL, 32097 |
| BOYD JEFF | Director | 463646 SR 200, YULEE, FL, 32097 |
| GARTNER JACK D | Director | 463646 SR 200, YULEE, FL, 32097 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2011-09-23 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2010-01-22 | 463646 SR 200, YULEE, FL 32090-7 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2010-01-22 |
| Domestic Profit | 2009-03-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
