| Entity Name: | PELT EYE CLINIC, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Inactive |
| Date Filed: | 01 Feb 1996 (29 years ago) |
| Date of dissolution: | 22 Sep 2023 (a year ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 22 Sep 2023 (a year ago) |
| Document Number: | P96000010070 |
| FEI/EIN Number | 59-3357063 |
| Address: | 4340 LAFAYETTE STREET, MARIANNA, FL 32446 |
| Mail Address: | P O BOX 6054, MARIANNA, FL 32447 |
| ZIP code: | 32446 |
| County: | Jackson |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1336173350 | 2006-07-10 | 2008-03-28 | PO BOX 6054, MARIANNA, FL, 324476054, US | 4340 LAFAYETTE ST, MARIANNA, FL, 324462916, US | |||||||||||||||||||||
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| Phone | +1 850-482-2336 |
| Fax | 8505265337 |
Authorized person
| Name | DR. ALAN E PELT |
| Role | PRESIDENT |
| Phone | 8504822336 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 620847900 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FUQUA, MATTHEW H | Agent | 4450 LAFAYETTE STREET, MARIANNA, FL 32446 |
| Name | Role | Address |
|---|---|---|
| PELT, ALAN EUGENE | President | 4565 RED OAK TRACE, MARIANNA, FL 32446 |
| Name | Role | Address |
|---|---|---|
| PELT, DAVID GLENN | Vice President | 4506 RED OAK TRACE, MARIANNA, FL 32446 |
| Name | Role | Address |
|---|---|---|
| PELT, DAVID GLENN | Secretary | 4506 RED OAK TRACE, MARIANNA, FL 32446 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2023-09-22 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2008-01-20 | FUQUA, MATTHEW H | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2008-01-20 | 4450 LAFAYETTE STREET, MARIANNA, FL 32446 | No data |
| CHANGE OF PRINCIPAL ADDRESS | 1999-04-01 | 4340 LAFAYETTE STREET, MARIANNA, FL 32446 | No data |
| CHANGE OF MAILING ADDRESS | 1999-04-01 | 4340 LAFAYETTE STREET, MARIANNA, FL 32446 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2022-02-25 |
| ANNUAL REPORT | 2021-01-30 |
| ANNUAL REPORT | 2020-01-19 |
| ANNUAL REPORT | 2019-01-26 |
| ANNUAL REPORT | 2018-01-14 |
| ANNUAL REPORT | 2017-01-10 |
| ANNUAL REPORT | 2016-01-25 |
| ANNUAL REPORT | 2015-01-12 |
| ANNUAL REPORT | 2014-01-13 |
| ANNUAL REPORT | 2013-01-10 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
