| Entity Name: | GREG PIENTKA, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 22 Apr 1998 (27 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 19 Oct 2016 (8 years ago) |
| Document Number: | P98000037026 |
| FEI/EIN Number | 650825869 |
| Mail Address: | 7741 Pine Tree Lane, West Palm Beach, FL, 33406, US |
| Address: | 640 W BOYNTON BEACH BLVD., BOYNTON BCH, FL, 33426-3637, US |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1508178450 | 2010-07-08 | 2013-03-21 | 640 W BOYNTON BEACH BLVD, BOYNTON BEACH, FL, 334263637, US | 640 W BOYNTON BEACH BLVD, BOYNTON BEACH, FL, 334263637, US | |||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||
| Phone | +1 561-732-8088 |
| Fax | 5617328112 |
Authorized person
| Name | DR. GREG PIENTKA |
| Role | CORPORATE PRESIDENT |
| Phone | 5617328088 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC 3038 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 620319100 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| PIENTKA GREG | Agent | 7741 Pine Tree Lane, West Palm Beach, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| PIENTKA GREG | President | 7741 Pine Tree Lane, West Palm Beach, FL, 33406 |
| Name | Role | Address |
|---|---|---|
| Pientka Kathleen M | Director | 7741 Pine Tree Ln, West Palm Beach, FL, 33406 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G17000024203 | PALM BEACH EYES OF BOYNTON BEACH | EXPIRED | 2017-03-07 | 2022-12-31 | No data | 640 W BOYNTON BEACH BLVD., BOYNTON BEACH, FL, 33426 |
| G16000022705 | PALM BEACH EYES VISION SOURCE | EXPIRED | 2016-03-02 | 2021-12-31 | No data | 640 W BOYNTON BEACH BLVD., BOYNTON BEACH, FL, 33426 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REINSTATEMENT | 2016-10-19 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2016-10-19 | 640 W BOYNTON BEACH BLVD., BOYNTON BCH, FL 33426-3637 | No data |
| REGISTERED AGENT NAME CHANGED | 2016-10-19 | PIENTKA, GREG | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2016-10-19 | 7741 Pine Tree Lane, West Palm Beach, FL 33406 | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2009-10-26 | 640 W BOYNTON BEACH BLVD., BOYNTON BCH, FL 33426-3637 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-30 |
| ANNUAL REPORT | 2023-03-16 |
| ANNUAL REPORT | 2022-02-01 |
| ANNUAL REPORT | 2021-04-29 |
| ANNUAL REPORT | 2020-06-10 |
| ANNUAL REPORT | 2019-04-29 |
| ANNUAL REPORT | 2018-04-03 |
| ANNUAL REPORT | 2017-03-10 |
| REINSTATEMENT | 2016-10-19 |
| ANNUAL REPORT | 2015-03-11 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
