| Entity Name: | R. THAD GOODWIN, MD, PA. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 21 Jan 1997 (28 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 12 Apr 2012 (13 years ago) |
| Document Number: | P97000005681 |
| FEI/EIN Number | 65-0727172 |
| Address: | 3416 Avocado Dr, Fort Myers, FL 33901 |
| Mail Address: | 3416 Avocado Dr, Fort Myers, FL 33901 |
| ZIP code: | 33901 |
| County: | Lee |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285813410 | 2007-10-24 | 2011-10-04 | 1510 ROYAL PALM SQUARE BLVD, STE 106, FORT MYERS, FL, 339191068, US | 1510 ROYAL PALM SQUARE BLVD, STE 106, FORT MYERS, FL, 339191068, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 239-939-3937 |
| Fax | 2392758045 |
Authorized person
| Name | ROBIN THAD GOODWIN |
| Role | PRESIDENT |
| Phone | 2399393937 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | ME0037950 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 042931700 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GOODWIN, R. THAD MD, PA. | Agent | 3416 Avocado Dr, Fort Myers, FL 33901 |
| Name | Role | Address |
|---|---|---|
| GOODWIN, R. THAD MD, PA. | President | 3416 Avocado Dr, Fort Myers, FL 33901 |
| Name | Role | Address |
|---|---|---|
| GOODWIN, R. THAD MD, PA. | Secretary | 3416 Avocado Dr, Fort Myers, FL 33901 |
| Name | Role | Address |
|---|---|---|
| GOODWIN, R. THAD MD, PA. | Treasurer | 3416 Avocado Dr, Fort Myers, FL 33901 |
| Name | Role | Address |
|---|---|---|
| GOODWIN, R. THAD MD, PA. | Director | 3416 Avocado Dr, Fort Myers, FL 33901 |
| Name | Role | Address |
|---|---|---|
| GOODWIN, R. THAD MD, PA. | Vice President | 3416 Avocado Dr, Fort Myers, FL 33901 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-23 | 3416 Avocado Dr, Fort Myers, FL 33901 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-23 | 3416 Avocado Dr, Fort Myers, FL 33901 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-23 | 3416 Avocado Dr, Fort Myers, FL 33901 | No data |
| PENDING REINSTATEMENT | 2012-04-12 | No data | No data |
| REINSTATEMENT | 2012-04-12 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2010-09-24 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-23 |
| ANNUAL REPORT | 2023-01-25 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-04-01 |
| ANNUAL REPORT | 2020-03-25 |
| ANNUAL REPORT | 2019-01-28 |
| ANNUAL REPORT | 2018-03-29 |
| ANNUAL REPORT | 2017-01-05 |
| ANNUAL REPORT | 2016-01-05 |
| ANNUAL REPORT | 2015-02-19 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
