| Entity Name: | DAVID Y. SHIPLEY, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 20 Mar 1997 (28 years ago) |
| Document Number: | P97000027159 |
| FEI/EIN Number | 650747828 |
| Address: | 201 SE 15th Terr, SUITE 102, DEERFIELD BEACH, FL, 33441, US |
| Mail Address: | 201 SE 15th Terr, SUITE 102, DEERFIELD BEACH, FL, 33441, US |
| ZIP code: | 33441 |
| County: | Broward |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538323530 | 2008-07-18 | 2018-08-30 | 201 SE 15TH TER STE 102, DEERFIELD BEACH, FL, 334414464, US | 1500 SE 3RD CT, SUITE 151, DEERFIELD BEACH, FL, 33441, US | |||||||||||||||||||||||||
|
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| Phone | +1 954-428-2002 |
| Fax | 9544274614 |
Authorized person
| Name | DR. DAVID Y SHIPLEY |
| Role | PRESIDENT |
| Phone | 9544282002 |
Taxonomy
| Taxonomy Code | 332H00000X - Eyewear Supplier |
| License Number | OPC002599 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 078954201 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SHIPLEY DAVID Y | Agent | 201 SE 15th Terr, DEERFIELD BEACH, FL, 33441 |
| Name | Role | Address |
|---|---|---|
| SHIPLEY DAVID Y | President | 5200 TAFT ST, HOLLYWOOD, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| SHIPLEY DAVID Y | Vice President | 5200 TAFT ST, HOLLYWOOD, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| SHIPLEY DAVID Y | Secretary | 5200 TAFT ST, HOLLYWOOD, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| SHIPLEY DAVID Y | Treasurer | 5200 TAFT ST, HOLLYWOOD, FL, 33021 |
| Name | Role | Address |
|---|---|---|
| SHIPLEY DAVID Y | Director | 5200 TAFT ST, HOLLYWOOD, FL, 33021 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G20000050575 | GUARDIAN EYECARE CENTER | ACTIVE | 2020-05-07 | 2025-12-31 | No data | 201 SE 15TH TERRACE, SUITE 102, DEERFIELD BEACH, FL, 33441 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2014-04-08 | 201 SE 15th Terr, SUITE 102, DEERFIELD BEACH, FL 33441 | No data |
| CHANGE OF MAILING ADDRESS | 2014-04-08 | 201 SE 15th Terr, SUITE 102, DEERFIELD BEACH, FL 33441 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2014-04-08 | 201 SE 15th Terr, SUITE 102, DEERFIELD BEACH, FL 33441 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-03-21 |
| ANNUAL REPORT | 2023-02-15 |
| ANNUAL REPORT | 2022-03-03 |
| ANNUAL REPORT | 2021-02-16 |
| ANNUAL REPORT | 2020-03-20 |
| ANNUAL REPORT | 2019-02-07 |
| ANNUAL REPORT | 2018-03-13 |
| ANNUAL REPORT | 2017-03-03 |
| ANNUAL REPORT | 2016-03-31 |
| ANNUAL REPORT | 2015-03-26 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
