| Entity Name: | EYE ASSOCIATES OF MID FLORIDA, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 14 Jan 2016 (9 years ago) |
| Document Number: | P16000005316 |
| FEI/EIN Number | 81-1097086 |
| Address: | 11794 E Colonial Dr, Orlando, FL, 32817, US |
| Mail Address: | 11794 E Colonial Dr, Orlando, FL, 32817, US |
| ZIP code: | 32817 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1902359003 | 2016-07-26 | 2024-02-02 | 11794 E COLONIAL DR, ORLANDO, FL, 328174626, US | 11794 E COLONIAL DR, ORLANDO, FL, 328174626, US | |||||||||||||||||||||||||
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| Phone | +1 407-904-4431 |
| Fax | 4079044438 |
Authorized person
| Name | DR. BRANDON EB MONDESIR |
| Role | OWNER |
| Phone | 4079044431 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC 4482 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 016166600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MONDESIR BRANDON O.D. | Agent | 1280 Spotted Sandpiper Loop, Winter Springs, FL, 32708 |
| Name | Role | Address |
|---|---|---|
| MONDESIR BRANDON O.D. | President | 11794 E Colonial Dr, Orlando, FL, 32817 |
| Name | Role | Address |
|---|---|---|
| MONDESIR BRANDON O.D. | Chief Executive Officer | 11794 E Colonial Dr, Orlando, FL, 32817 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000048961 | MODERN EYES AT ALAFAYA | ACTIVE | 2022-04-18 | 2027-12-31 | No data | 11794 E COLONIAL DR, ORLANDO, FL, 32817 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2024-03-08 | 1280 Spotted Sandpiper Loop, Winter Springs, FL 32708 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-03-17 | 11794 E Colonial Dr, Orlando, FL 32817 | No data |
| CHANGE OF MAILING ADDRESS | 2021-03-17 | 11794 E Colonial Dr, Orlando, FL 32817 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-08 |
| ANNUAL REPORT | 2023-01-05 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-03-17 |
| ANNUAL REPORT | 2020-04-02 |
| ANNUAL REPORT | 2019-04-05 |
| ANNUAL REPORT | 2018-01-11 |
| ANNUAL REPORT | 2017-02-01 |
| Domestic Profit | 2016-01-14 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
