| Entity Name: | OKALOOSA OPHTHALMOLOGY PEDIATRIC & ADULT EYE CARE CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 05 Feb 2016 (9 years ago) |
| Document Number: | P16000012198 |
| FEI/EIN Number | 47-5519145 |
| Address: | 4100 S Ferdon Blvd, SUITE C2, CRESTVIEW, FL 32536 |
| Mail Address: | 4100 S Ferdon Blvd, SUITE C2, CRESTVIEW, FL 32536 |
| ZIP code: | 32536 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1831543362 | 2016-04-21 | 2016-10-24 | 1299 INDUSTRIAL DR, SUITE 200, CRESTVIEW, FL, 325398946, US | 1299 INDUSTRIAL DR, SUITE 200, CRESTVIEW, FL, 325398946, US | |||||||||||||||||||||||||||
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| Phone | +1 850-683-3937 |
| Fax | 8506830227 |
Authorized person
| Name | TIFFANY KRUGER |
| Role | OWNER |
| Phone | 8508262903 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | MYHJK |
| State | FL |
| Issuer | MEDICAID |
| Number | 017548800 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| KRUGER, TIFFANY L | Agent | 4100 S Ferdon Blvd, SUITE C2, CRESTVIEW, FL 32536 |
| Name | Role | Address |
|---|---|---|
| KRUGER, TIFFANY L | President | 4100 S FERDON BLVD, STE C2 CRESTVIEW, FL 32536 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2020-03-19 | 4100 S Ferdon Blvd, SUITE C2, CRESTVIEW, FL 32536 | No data |
| CHANGE OF MAILING ADDRESS | 2020-03-19 | 4100 S Ferdon Blvd, SUITE C2, CRESTVIEW, FL 32536 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2020-03-19 | 4100 S Ferdon Blvd, SUITE C2, CRESTVIEW, FL 32536 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2025-01-24 |
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-03-06 |
| ANNUAL REPORT | 2022-02-03 |
| ANNUAL REPORT | 2021-03-11 |
| ANNUAL REPORT | 2020-03-19 |
| ANNUAL REPORT | 2019-04-03 |
| ANNUAL REPORT | 2018-01-23 |
| ANNUAL REPORT | 2017-01-10 |
| Domestic Profit | 2016-02-05 |
Date of last update: 19 Feb 2025
Sources: Florida Department of State
