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  5. RUSSELL STACKHOUSE, M.D., P.A.

RUSSELL STACKHOUSE, M.D., P.A. - Florida Company Profile

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Company Details

Entity Name: RUSSELL STACKHOUSE, M.D., P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Active
Date Filed: 05 Jun 2018 (7 years ago)
Document Number: P18000050392
FEI/EIN Number 83-0953140
Address: 6 S 14th Street, FERNANDINA BEACH, FL, 32034, US
Mail Address: 6 S 14th Street, FERNANDINA BEACH, FL, 32034, US
ZIP code: 32034
City: Fernandina Beach
County: Nassau
Place of Formation: FLORIDA

Key Officers & Management

Name Role Address
STACKHOUSE RUSSELL M.D. Director 6 S 14th Street, FERNANDINA BEACH, FL, 32034
STACKHOUSE RUSSELL M.D. Agent 6 S 14th Street, FERNANDINA BEACH, FL, 32034

Unique Entity ID

Unique Entity ID:
CWZXCK5LTTJ7
UEI Expiration Date:
2025-01-24

Business Information

Activation Date:
2024-01-29
Initial Registration Date:
2024-01-25

National Provider Identifier

NPI Number:
1538655014
Certification Date:
2022-12-13
Link:
View on NPI website

Authorized Person:

Name:
NICHOLE RENE BARNETT
Role:
PRACTICE ADMINISTRATOR
Phone:
9042615741

Taxonomy:

Selected Taxonomy:
207XX0004X - Orthopaedic Foot and Ankle Surgery Physician
Is Primary:
No
Selected Taxonomy:
207W00000X - Ophthalmology Physician
Is Primary:
Yes

Contacts:

Phone:
+1 904-261-5741
Fax:
9042617383

Form 5500 Series

Employer Identification Number (EIN):
830953140
Plan Year:
2024
Number Of Participants:
77
Sponsors Telephone Number:
9042615741
File:
View File
Plan Year:
2023
Number Of Participants:
84
Sponsors Telephone Number:
9042615741
File:
View File
Plan Year:
2022
Number Of Participants:
83
Sponsors Telephone Number:
9042615741
File:
View File
Plan Year:
2021
Number Of Participants:
52
Sponsors Telephone Number:
9042615741
File:
View File
Plan Year:
2020
Number Of Participants:
34
Sponsors Telephone Number:
9042615741
File:
View File

Fictitious Names

Registration Number Fictitious Name Status Filed Date Expiration Date Cancellation Date Mailing Address
G18000131846 COASTAL VISION CENTER ACTIVE 2018-12-13 2028-12-31 - 6 S 14TH STREET, FERNANDINA BEACH, FL, 32034

Events

Event Type Filed Date Value Description
CHANGE OF PRINCIPAL ADDRESS 2019-04-25 6 S 14th Street, FERNANDINA BEACH, FL 32034 -
CHANGE OF MAILING ADDRESS 2019-04-25 6 S 14th Street, FERNANDINA BEACH, FL 32034 -
REGISTERED AGENT ADDRESS CHANGED 2019-04-25 6 S 14th Street, FERNANDINA BEACH, FL 32034 -

Documents

Name Date
ANNUAL REPORT 2025-01-23
ANNUAL REPORT 2024-02-02
ANNUAL REPORT 2023-01-19
ANNUAL REPORT 2022-02-10
ANNUAL REPORT 2021-02-02
ANNUAL REPORT 2020-03-03
ANNUAL REPORT 2019-04-25
Domestic Profit 2018-06-05

USAspending Awards / Financial Assistance

Date:
2024-09-04
Link:
View on USAspending
Awarding Agency Name:
Department of Agriculture
Transaction Description:
REAP RENEWABLE ENERGY SYSTEM (RES) GRANT UNRESTRICTED AMOUNT
Obligated Amount:
74417.00
Face Value Of Loan:
0.00
Total Face Value Of Loan:
0.00
Date:
2021-01-29
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
367900.00
Total Face Value Of Loan:
367900.00
Date:
2020-04-16
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
288100.00
Total Face Value Of Loan:
288100.00
Date:
2020-04-16
Link:
View on USAspending
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
288100.00
Total Face Value Of Loan:
288100.00

Trademarks

Serial Number:
98350197
Mark:
COASTAL VISION CENTER
Status:
Registered. The registration date is used to determine when post-registration maintenance documents are due.
Mark Type:
Service Mark
Application Filing Date:
2024-01-10
Mark Drawing Type:
4 - STANDARD CHARACTER MARK
Mark Literal Elements:
COASTAL VISION CENTER
USPTO Link:
View Trademark on United States Patent and Trademark Office Website

Goods And Services

For:
Laser vision correction services; Laser vision surgery services; Ophthalmology services; Optometric services; Optometry services
First Use:
1981-01-01
International Classes:
044 - Primary Class
Class Status:
ACTIVE

Paycheck Protection Program

Jobs Reported:
33
Initial Approval Amount:
$367,900
Date Approved:
2021-01-29
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$367,900
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$370,823.04
Servicing Lender:
First-Citizens Bank & Trust Company
Use of Proceeds:
Payroll: $367,895
Utilities: $1
Jobs Reported:
33
Initial Approval Amount:
$288,100
Date Approved:
2020-04-15
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$288,100
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$291,020.47
Servicing Lender:
First-Citizens Bank & Trust Company
Use of Proceeds:
Payroll: $288,100

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6 S 14th Street, FERNANDINA BEACH, FL, 32034, US

CVC RE HOLDINGS, LLC
Florida Limited Liability Co.
CVC RE HOLDINGS, LLC, which currently Active, has registered address 6 S 14th Street, FERNANDINA BEACH, FL, 32034, US.
CVC RE HOLDINGS, LLC
Florida Limited Liability Co.
CVC RE HOLDINGS, LLC, which currently Active, has registered address 6 S 14th Street, FERNANDINA BEACH, FL, 32034, US.

Date of last update: 01 Aug 2025

Sources: Florida Department of State

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