| Entity Name: | JERI D. GRAHAM, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 29 Apr 2010 (15 years ago) |
| Document Number: | P10000037347 |
| FEI/EIN Number | 27-2471872 |
| Address: | 918 Floral Drive, Orlando, FL 32803 |
| Mail Address: | 918 Floral Drive, Orlando, FL 32803 |
| ZIP code: | 32803 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619314978 | 2013-05-28 | 2014-09-02 | 1239 SR 436, SUITE 101, CASSELBERRY, FL, 327072707, US | 1239 SR 436, SUITE 101, CASSELBERRY, FL, 327072707, US | |||||||||||||||||||||||||||||||
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| Phone | +1 407-263-3937 |
| Fax | 4076719656 |
Authorized person
| Name | DR. JERI D GRAHAM |
| Role | PRESIDENT |
| Phone | 4072633937 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC2446 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 078790600 |
| State | FL |
| Issuer | INDIIDUAL NPI |
| Number | 1851328496 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GRAHAM, JERI D | Agent | 918 Floral Drive, Orlando, FL 32803 |
| Name | Role | Address |
|---|---|---|
| GRAHAM, JERI D | Director | 918 Floral Drive, Orlando, FL 32803 |
| Name | Role | Address |
|---|---|---|
| GRAHAM, JERI D | President | 918 Floral Drive, Orlando, FL 32803 |
| Name | Role | Address |
|---|---|---|
| GRAHAM, JERI D | Secretary | 918 Floral Drive, Orlando, FL 32803 |
| Name | Role | Address |
|---|---|---|
| GRAHAM, JERI D | Treasurer | 918 Floral Drive, Orlando, FL 32803 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-04-05 | 918 Floral Drive, Orlando, FL 32803 | No data |
| CHANGE OF MAILING ADDRESS | 2024-04-05 | 918 Floral Drive, Orlando, FL 32803 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-04-05 | 918 Floral Drive, Orlando, FL 32803 | No data |
| REGISTERED AGENT NAME CHANGED | 2023-04-13 | GRAHAM, JERI D | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-02-22 |
| AMENDED ANNUAL REPORT | 2024-04-05 |
| ANNUAL REPORT | 2024-02-07 |
| Reg. Agent Change | 2023-04-13 |
| Reg. Agent Resignation | 2023-03-23 |
| ANNUAL REPORT | 2023-02-09 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-01-20 |
| ANNUAL REPORT | 2020-01-18 |
| ANNUAL REPORT | 2019-02-07 |
Date of last update: 23 Feb 2025
Sources: Florida Department of State
