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  5. ANDREW ROTHBERG, O.D., P.A.

ANDREW ROTHBERG, O.D., P.A.

Company Details

Entity Name: ANDREW ROTHBERG, O.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Florida Profit Corporation
Status: Active
Date Filed: 16 Jun 2014 (11 years ago)
Document Number: P14000052064
FEI/EIN Number 47-1247089
Address: 12950 RACE TRACK RD STE 111, TAMPA, FL 33626
Mail Address: 12950 RACE TRACK RD STE 111, TAMPA, FL 33626
ZIP code: 33626
County: Hillsborough
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
EAGLE EYE VISION CARE 401(K) PLAN 2023 471247089 2024-05-06 ANDREW ROTHBERG, O.D., P.A. 6
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-15
Business code 621320
Sponsor’s telephone number 8138549000
Plan sponsor’s address 12950 RACE TRACK ROAD, SUITE 111, TAMPA, FL, 33626

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2024-05-06
Name of individual signing QIAN LIU
Valid signature Filed with authorized/valid electronic signature
EAGLE EYE VISION CARE 401(K) PLAN 2022 471247089 2023-05-26 ANDREW ROTHBERG, O.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-15
Business code 621320
Sponsor’s telephone number 8138549000
Plan sponsor’s address 12950 RACE TRACK ROAD, SUITE 111, TAMPA, FL, 33626

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1412 CHAPIN AVENUE, BURLINGAME, CA, 94010
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2023-05-26
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
EAGLE EYE VISION CARE 401(K) PLAN 2021 471247089 2022-06-01 ANDREW ROTHBERG, O.D., P.A. 4
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-15
Business code 621320
Sponsor’s telephone number 8138549000
Plan sponsor’s address 12950 RACE TRACK ROAD, SUITE 111, TAMPA, FL, 33626

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 1645 E 6TH STREET, SUITE 200, AUSTIN, TX, 78702
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2022-06-01
Name of individual signing CHRISTINE RIMER
Valid signature Filed with authorized/valid electronic signature
EAGLE EYE VISION CARE 401(K) PLAN 2020 471247089 2021-05-04 ANDREW ROTHBERG, O.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-15
Business code 621320
Sponsor’s telephone number 8138549000
Plan sponsor’s address 12950 RACE TRACK ROAD, SUITE 111, TAMPA, FL, 33626

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2021-05-04
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
EAGLE EYE VISION CARE 401(K) PLAN 2019 471247089 2020-05-20 ANDREW ROTHBERG, O.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-15
Business code 621320
Sponsor’s telephone number 8138549000
Plan sponsor’s address 12950 RACE TRACK ROAD, SUITE 108, TAMPA, FL, 33626

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2020-05-20
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature
EAGLE EYE VISION CARE 401(K) PLAN 2018 471247089 2019-07-17 ANDREW ROTHBERG, O.D., P.A. 3
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2018-10-15
Business code 621320
Sponsor’s telephone number 8138549000
Plan sponsor’s address 12950 RACE TRACK ROAD, SUITE 108, TAMPA, FL, 33626

Plan administrator’s name and address
Administrator’s EIN 474474775
Plan administrator’s name GUIDELINE, INC.
Plan administrator’s address 3050 S DELAWARE ST, #202, SAN MATEO, CA, 94403
Administrator’s telephone number 8882283491

Signature of
Role Plan administrator
Date 2019-07-17
Name of individual signing CAROL HO
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
ROTHBERG, ANDREW Agent 12950 RACE TRACK RD STE 111, TAMPA, FL 33626

President

Name Role Address
ROTHBERG, ANDREW President 12950 RACE TRACK RD STE 111, TAMPA, FL 33626

Secretary

Name Role Address
ROTHBERG, ANDREW Secretary 12950 RACE TRACK RD STE 111, TAMPA, FL 33626

Treasurer

Name Role Address
ROTHBERG, ANDREW Treasurer 12950 RACE TRACK RD STE 111, TAMPA, FL 33626

Director

Name Role Address
ROTHBERG, ANDREW Director 12950 RACE TRACK RD STE 111, TAMPA, FL 33626

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G14000079103 EAGLE EYE VISION CARE ACTIVE 2014-07-31 2029-12-31 No data 12950 RACE TRACK ROAD, SUITE #111, TAMPA, FL, 33626

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2021-01-20 12950 RACE TRACK RD STE 111, TAMPA, FL 33626 No data
CHANGE OF MAILING ADDRESS 2021-01-20 12950 RACE TRACK RD STE 111, TAMPA, FL 33626 No data
REGISTERED AGENT ADDRESS CHANGED 2021-01-20 12950 RACE TRACK RD STE 111, TAMPA, FL 33626 No data

Documents

Name Date
ANNUAL REPORT 2024-02-10
ANNUAL REPORT 2023-01-31
ANNUAL REPORT 2022-02-02
ANNUAL REPORT 2021-01-20
ANNUAL REPORT 2020-01-19
ANNUAL REPORT 2019-02-14
ANNUAL REPORT 2018-01-17
ANNUAL REPORT 2017-01-12
ANNUAL REPORT 2016-03-09
ANNUAL REPORT 2015-04-05

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ROTHBERG, ANDREW

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Related by address

No related companies by address

Date of last update: 21 Jan 2025

Sources: Florida Department of State

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