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Tuscaloosa Ophthalmology, Inc.

Details

Name: Tuscaloosa Ophthalmology, Inc.
Jurisdiction: Alabama
Legal type: Domestic Corporation
Status: Exists
Date of registration: 17 Sep 1992 (32 years ago)
Entity Number: 000-152-144
Register Number: 000152144
Historical Names: Tuscaloosa Ophtalomolgy, P.C.
Southeastern Eye Specialists, P.C.
Tuscaloosa Ophthalmology, P.C.
County: Tuscaloosa
Place of Formation: Tuscaloosa County
Registered Office Street Address: 2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104
Registered Office Street Address ZIP Code: 36104
Principal Address: 535 JACK WARNER PKWY STE B-1TUSCALOOSA, AL 35405
Principal Address ZIP Code: 35405
Authorized Capital: 5000 @ $1.00 PV

Activities PRACTICE OF MEDICINE

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1487728218 2006-11-20 2020-12-01 535 JACK WARNER PKWY NE STE B1, TUSCALOOSA, AL, 354045715, US 535 JACK WARNER PKWY NE STE B1, TUSCALOOSA, AL, 354045715, US

Contacts
Phone +1 205-556-2121
Fax 2055540152

Authorized person
Name DR. ERNEST VAN JOHNSON
Role PHYSICIAN OWNER
Phone 2055562121

Taxonomy
Taxonomy Code 156FX1100X - Ophthalmic Technician/Technologist
License Number 11457
State AL
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 529202430
State AL

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLAN 2021 631074848 2022-06-29 TUSCALOOSA OPHTHALMOLOGY, P.C. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLAN 2020 631074848 2022-02-01 TUSCALOOSA OPHTHALMOLOGY, P.C. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLAN 2019 631074848 2021-06-07 TUSCALOOSA OPHTHALMOLOGY, P.C. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLAN 2018 631074848 2020-07-13 TUSCALOOSA OPHTHALMOLOGY, P.C. 33
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLAN 2017 631074848 2019-07-10 TUSCALOOSA OPHTHALMOLOGY, P.C. 35
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLAN 2016 631074848 2018-01-16 TUSCALOOSA OPHTHALMOLOGY, P.C. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLAN 2015 631074848 2017-02-14 TUSCALOOSA OPHTHALMOLOGY, P.C. 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLAN 2014 631074848 2016-05-10 TUSCALOOSA OPHTHALMOLOGY, P.C. 29
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715
TUSCALOOSA OPHTHALMOLOGY, P.C. PROFIT SHARING PLA 2013 631074848 2015-06-08 TUSCALOOSA OPHTHALMOLOGY, P.C. 30
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NORTHEAST, SUITE B-1, TUSCALOOSA, AL, 354045715

Signature of
Role Plan administrator
Date 2015-06-08
Name of individual signing STEPHEN A. BROOKS
TUSCALOOSA OPHTHALMOLOGY, PC PROFIT SHARING PLAN 2012 631074848 2014-07-14 TUSCALOOSA OPHTHALMOLOGY, P.C. 34
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1992-10-01
Business code 621111
Sponsor’s telephone number 2055562121
Plan sponsor’s address 535 JACK WARNER PARKWAY NE NO. B-1, TUSCALOOSA, AL, 35404

Signature of
Role Plan administrator
Date 2014-07-14
Name of individual signing E. VAN JOHNSON M.D.
Role Employer/plan sponsor
Date 2014-07-14
Name of individual signing E. VAN JOHNSON M.D.

Agent

Name Role Address
C T CORPORATION SYSTEM Agent 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104

Incorporator

Name Role Address
KUDIRKA, A G Incorporator 535 JACK WARNER PKWY STE B-1TUSCALOOSA, AL 35405
JOHNSON, E V Incorporator 535 JACK WARNER PKWY STE B-1TUSCALOOSA, AL 35405

Events

Event Date Event Type Old Value New Value
2020-10-29 Name Change Tuscaloosa Ophthalmology, P.C. Tuscaloosa Ophthalmology, Inc.
2003-07-24 Name Change Southeastern Eye Specialists, P.C. Tuscaloosa Ophthalmology, P.C.
1997-05-14 Name Change Tuscaloosa Ophtalomolgy, P.C. Southeastern Eye Specialists, P.C.

Related by officers

C T CORPORATION SYSTEM

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JOHNSON, E V

Riverside Optical, Inc. J & K Rental, LLC

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2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104

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535 JACK WARNER PKWY STE B-1TUSCALOOSA, AL 35405

Riverside Optical, Inc. J & K Rental, LLC

Date of last update: 01 Aug 2024

Sources: Alabama Secretary of State

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