| Entity Name: | RIVERSIDE EYE AND LASER SPECIALISTS, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 17 Sep 2018 (6 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 23 Nov 2021 (3 years ago) |
| Document Number: | P18000078403 |
| FEI/EIN Number | 83-1933117 |
| Address: | 1034 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32204, US |
| Mail Address: | 1034 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32204, US |
| ZIP code: | 32204 |
| County: | Duval |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1154805760 | 2018-09-19 | 2018-09-19 | 1034 RIVERSIDE AVE, JACKSONVILLE, FL, 322044123, US | 1034 RIVERSIDE AVE, JACKSONVILLE, FL, 322044123, US | |||||||||||||||||||||
|
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| Phone | +1 904-354-2114 |
| Fax | 9043542122 |
Authorized person
| Name | DR. BRITTANY R. AGEE |
| Role | OWNER |
| Phone | 9043551525 |
Taxonomy
| Taxonomy Code | 174400000X - Specialist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS AND BLUE SHIELD |
| Number | 151LL |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AGEE BRITTANY R | Agent | 4468 HUNTERSTON LANE, JACKSONVILLE, FL, 32224 |
| Name | Role | Address |
|---|---|---|
| AGEE BRITTANY R | President | 1034 RIVERSIDE AVENUE, JACKSONVILLE, FL, 32204 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2021-11-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2021-11-23 | 1034 RIVERSIDE AVENUE, JACKSONVILLE, FL 32204 | No data |
| REGISTERED AGENT NAME CHANGED | 2021-11-23 | AGEE, BRITTANY R | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2021-11-23 | 4468 HUNTERSTON LANE, JACKSONVILLE, FL 32224 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2021-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-08 |
| ANNUAL REPORT | 2023-01-26 |
| ANNUAL REPORT | 2022-03-10 |
| REINSTATEMENT | 2021-11-23 |
| ANNUAL REPORT | 2020-02-06 |
| ANNUAL REPORT | 2019-02-14 |
| Domestic Profit | 2018-09-17 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
