| Entity Name: | REBECCA J SIMS OD PA |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 16 Jun 2022 (3 years ago) |
| Document Number: | P22000047313 |
| FEI/EIN Number | 92-0950762 |
| Address: | 3606 S CLARK AVE, TAMPA, FL, 33629 |
| Mail Address: | 3606 S CLARK AVE, TAMPA, FL, 33629 |
| ZIP code: | 33629 |
| County: | Hillsborough |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1487363966 | 2022-11-23 | 2022-11-23 | 3606 S CLARK AVE, TAMPA, FL, 336298519, US | 3604 MADACA LN, TAMPA, FL, 336182057, US | |||||||||||||||||||||||||
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| Phone | +1 813-962-1006 |
Authorized person
| Name | DANA LEONARD |
| Role | CREDENTIALING |
| Phone | 8139667681 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | AETNA |
| Number | 5261666 |
| State | FL |
| Issuer | BCBS |
| Number | 20995H |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SIMS REBECCA J | Agent | 3606 S CLARK AVE, TAMPA, FL, 33629 |
| Name | Role | Address |
|---|---|---|
| Sims Rebecca | pres | 3606 S Clark Avenue, Tampa, FL, 33629 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G22000154438 | CARROLLWOOD OPTICAL | ACTIVE | 2022-12-15 | 2027-12-31 | No data | 3604 MADACA LANE, TAMPA, FL, 33618 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-05-31 |
| ANNUAL REPORT | 2023-04-25 |
| Domestic Profit | 2022-06-16 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
