| Entity Name: | OPTIC WISE CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 10 Sep 2021 (3 years ago) |
| Document Number: | P21000080380 |
| FEI/EIN Number | 87-2598766 |
| Address: | 13858 SW 56th ST, MIAMI, FL, 33175, US |
| Mail Address: | 13858 SW 56th ST, MIAMI, FL, 33175, US |
| ZIP code: | 33175 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1679298269 | 2022-10-06 | 2022-10-06 | 13858 SW 56TH ST, MIAMI, FL, 331756060, US | 13858 SW 56TH ST, MIAMI, FL, 331756060, US | |||||||||||||||||||||||||||
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| Phone | +1 786-391-0980 |
| Fax | 7862210415 |
Authorized person
| Name | MRS. LAURA FIGUEROA |
| Role | OPTICIAN |
| Phone | 7863910980 |
Taxonomy
| Taxonomy Code | 156FX1800X - Optician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | DO7744 |
| State | FL |
| Issuer | MEDICAID |
| Number | OE2723 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| RIOSECO MERONO ILEANA | Agent | 13858 SW 56th ST, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| RIOSECO MERONO ILEANA | President | 13858 Sw 56th St, MIAMI, FL, 33175 |
| Name | Role | Address |
|---|---|---|
| Valdes Mario L | Vice President | 13858 SW 56th ST, MIAMI, FL, 33175 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2022-02-01 | 13858 SW 56th ST, Suite 165, MIAMI, FL 33175 | No data |
| CHANGE OF MAILING ADDRESS | 2022-02-01 | 13858 SW 56th ST, Suite 165, MIAMI, FL 33175 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2022-02-01 | 13858 SW 56th ST, Suite 165, MIAMI, FL 33175 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-19 |
| ANNUAL REPORT | 2023-03-05 |
| ANNUAL REPORT | 2022-02-01 |
| Domestic Profit | 2021-09-10 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
