| Entity Name: | EYE ASSOCIATES OF SOUTHWEST FLORIDA, M.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 08 Jan 1999 (26 years ago) |
| Document Number: | P99000002243 |
| FEI/EIN Number | 650886142 |
| Address: | 7955 AIRPORT PULLING ROAD NORTH, SUITE 104, NAPLES, FL, 34109 |
| Mail Address: | 4225 EVANS AVENUE, FORT MYERS, FL, 33901 |
| ZIP code: | 34109 |
| County: | Collier |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1619937554 | 2006-03-24 | 2021-02-25 | 4225 EVANS AVE, FORT MYERS, FL, 339019311, US | 7955 AIRPORT PULLING RD N, SUITE 104, NAPLES, FL, 341091794, US | |||||||||||||||||||||
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| Phone | +1 239-593-7747 |
| Fax | 2395936650 |
Authorized person
| Name | STEPHEN E SMITH |
| Role | PRESIDENT |
| Phone | 2399368655 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 254549702 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| SMITH STEPHEN EDr. | Agent | 4225 EVANS AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| SMITH STEPHEN E | President | 4225 EVANS AVENUE, FORT MYERS, FL, 33901 |
| Name | Role | Address |
|---|---|---|
| Lighthall Meghan | Auth | 4225 EVANS AVENUE, FORT MYERS, FL, 33901 |
| Registration Number | Fictitious Name | Status | Filed Date | Expiration Date | Cancellation Date | Mailing Address |
|---|---|---|---|---|---|---|
| G99039900230 | EYE ASSOCIATES | EXPIRED | 1999-02-09 | 2024-12-31 | No data | 4225 EVANS AVENUE, FORT MYERS, FL, 33901 |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
