| Entity Name: | DR. R. KEITH AMIEL - OPTOMETRIST, P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 09 Dec 1998 (26 years ago) |
| Date of dissolution: | 25 Sep 2009 (15 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 25 Sep 2009 (15 years ago) |
| Document Number: | P98000103018 |
| FEI/EIN Number | 593546789 |
| Address: | 36 NE EGLIN PKWY, FORT WALTON BEACH, FL, 32548 |
| Mail Address: | 36 NE EGLIN PKWY, FORT WALTON BEACH, FL, 32548 |
| ZIP code: | 32548 |
| County: | Okaloosa |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1043526205 | 2010-08-26 | 2010-10-11 | 36 EGLIN PKWY NE, FORT WALTON BEACH, FL, 325484915, US | 36 EGLIN PKWY NE, FORT WALTON BEACH, FL, 325484915, US | |||||||||||||||||||||||||||||||
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| Phone | +1 850-243-3111 |
| Fax | 8502004373 |
Authorized person
| Name | DR. R. KEITH AMIEL |
| Role | OWNER-PRESIDENT |
| Phone | 8502433111 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | OPC874 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 19461 |
| State | FL |
| Issuer | MEDICAID |
| Number | 078299300 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| AMIEL R. KEITH D | Agent | 36 NE EGLIN PKWY, FORT WALTON BEACH, FL, 32548 |
| Name | Role | Address |
|---|---|---|
| AMIEL R. KEITH D | Director | 36 NE EGLIN PKWY, FORT WALTON BEACH, FL, 32548 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2009-09-25 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2008-02-29 |
| ANNUAL REPORT | 2007-05-01 |
| ANNUAL REPORT | 2006-04-10 |
| ANNUAL REPORT | 2005-05-02 |
| ANNUAL REPORT | 2004-04-29 |
| ANNUAL REPORT | 2003-05-05 |
| ANNUAL REPORT | 2002-04-03 |
| ANNUAL REPORT | 2001-04-11 |
| ANNUAL REPORT | 2000-04-03 |
| ANNUAL REPORT | 1999-04-06 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
