| Entity Name: | EYE CARE ASSOCIATES OF BREVARD, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 13 Oct 1995 (29 years ago) |
| Date of dissolution: | 28 Sep 2018 (6 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 28 Sep 2018 (6 years ago) |
| Document Number: | P95000079487 |
| FEI/EIN Number | 593341216 |
| Address: | 3200 N. WICKHAM RD., SUITE 1, MELBOURNE, FL, 32935, US |
| Mail Address: | 3200 N. WICKHAM RD., SUITE 1, MELBOURNE, FL, 32935, US |
| ZIP code: | 32935 |
| County: | Brevard |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1528210481 | 2008-10-22 | 2015-07-14 | 3200 N WICKHAM RD, SUITE #1, MELBOURNE, FL, 329352321, US | 3200 N WICKHAM RD, SUITE #1, MELBOURNE, FL, 329352321, US | |||||||||||||||||||||||||||||||||
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| Phone | +1 321-253-3550 |
| Fax | 3212533591 |
Authorized person
| Name | DR. ANNE GREGAS |
| Role | PRESIDENT |
| Phone | 3212533550 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OP2792 |
| State | FL |
| Is Primary | Yes |
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OP2715 |
| State | FL |
| Is Primary | No |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 620058300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FALLACE JAMES H | Agent | 1900 S HICKORY STREET, MELBOURNE, FL, 32901 |
| Name | Role | Address |
|---|---|---|
| MANGUIKIAN SHAHAN | President | 8061 Spyglass Hill South, Viera, FL, 32940 |
| Name | Role | Address |
|---|---|---|
| GREGAS ANNE | Secretary | 3200 N. WICKHAM RD., #1, MELBOURNE, FL, 32935 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2018-09-28 | No data | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2009-02-17 | 1900 S HICKORY STREET, MELBOURNE, FL 32901 | No data |
| REGISTERED AGENT NAME CHANGED | 2009-02-17 | FALLACE, JAMES H | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1998-02-11 | 3200 N. WICKHAM RD., SUITE 1, MELBOURNE, FL 32935 | No data |
| CHANGE OF MAILING ADDRESS | 1998-02-11 | 3200 N. WICKHAM RD., SUITE 1, MELBOURNE, FL 32935 | No data |
| REINSTATEMENT | 1996-12-20 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 1996-08-23 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2017-04-03 |
| ANNUAL REPORT | 2016-04-04 |
| ANNUAL REPORT | 2015-01-29 |
| ANNUAL REPORT | 2014-03-25 |
| ANNUAL REPORT | 2013-04-27 |
| ANNUAL REPORT | 2012-04-30 |
| ANNUAL REPORT | 2011-04-08 |
| ANNUAL REPORT | 2010-03-02 |
| ANNUAL REPORT | 2009-02-17 |
| ANNUAL REPORT | 2008-04-24 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
