| Entity Name: | DOUGLAS J. MACHIELA, O.D., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Profit Corporation |
| Status: | Active |
| Date Filed: | 01 May 1991 (34 years ago) |
| Document Number: | S53859 |
| FEI/EIN Number | 65-0275321 |
| Address: | 5403 10th Ave N, West Palm Beach, FL 33406 |
| Mail Address: | 5403 10th Ave N, West Palm Beach, FL 33406 |
| ZIP code: | 33406 |
| County: | Palm Beach |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1285892992 | 2008-05-29 | 2008-05-29 | 5493 10TH AVE N, GREENACRES, FL, 334632056, US | 5493 10TH AVE N, GREENACRES, FL, 334632056, US | |||||||||||||||||||||||||
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| Phone | +1 561-439-0075 |
| Fax | 5614390413 |
Authorized person
| Name | DR. DOUGLAS J. MACHIELA |
| Role | PRESIDENT |
| Phone | 5614390075 |
Taxonomy
| Taxonomy Code | 332H00000X - Eyewear Supplier |
| License Number | OPC2245 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 078761200 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MACHIELA, DOUGLAS J. | Agent | 5403 10th Ave N, West Palm Beach, FL 33406 |
| Name | Role | Address |
|---|---|---|
| MACHIELA, DOUGLAS J. | President | 3704 VALLEY PARK WAY, LAKE WORTH, FL |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| CHANGE OF PRINCIPAL ADDRESS | 2024-01-04 | 5403 10th Ave N, West Palm Beach, FL 33406 | No data |
| CHANGE OF MAILING ADDRESS | 2024-01-04 | 5403 10th Ave N, West Palm Beach, FL 33406 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2024-01-04 | 5403 10th Ave N, West Palm Beach, FL 33406 | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-04 |
| ANNUAL REPORT | 2023-01-04 |
| ANNUAL REPORT | 2022-02-02 |
| ANNUAL REPORT | 2021-01-14 |
| ANNUAL REPORT | 2020-01-20 |
| ANNUAL REPORT | 2019-01-03 |
| ANNUAL REPORT | 2018-01-15 |
| ANNUAL REPORT | 2017-01-17 |
| ANNUAL REPORT | 2016-03-10 |
| ANNUAL REPORT | 2015-02-03 |
Date of last update: 03 Feb 2025
Sources: Florida Department of State
