| Name: | Song Eye Center, PC |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Exists |
| Date of registration: | 20 Sep 1996 (28 years ago) |
| Entity Number: | 000-182-379 |
| Register Number: | 000182379 |
| County: | Dallas |
| Place of Formation: | Dallas County |
| Principal Address: | SELMA, AL |
| Registered Office Street Address: | 1013 MEDICAL CENTER PKWY STE DSELMA, AL 36701 |
| Registered Office Street Address ZIP Code: | 36701 |
| Authorized Capital: | 100 |
Activities
PRACTICE OF MEDICINE - OPTHALMOLOGY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1538268008 | 2006-09-21 | 2008-03-14 | 1100 MEDICAL CENTER PKWY, SELMA, AL, 367016794, US | 1100 MEDICAL CENTER PKWY, SELMA, AL, 367016794, US | |||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||
| Phone | +1 334-874-8787 |
| Fax | 3348748780 |
Authorized person
| Name | DAE YONG SONG |
| Role | PRESIDENT/DOCTOR |
| Phone | 3348748787 |
Taxonomy
| Taxonomy Code | 156FX1100X - Ophthalmic Technician/Technologist |
| License Number | 045662 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | PALMETTO |
| Number | 1143210001 |
| State | AL |
| Issuer | MEDICARE |
| Number | J143 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SONG EYE CENTER PC DEFINED BENEFIT PLAN & TRUST | 2021 | 861078863 | 2023-09-06 | SONG EYE CENTER PC | 2 | |||||||||||||||||||||
|
||||||||||||||||||||||||||
| Role | Plan administrator |
| Date | 2023-09-07 |
| Name of individual signing | DAE SONG |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-12-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348748787 |
| Plan sponsor’s address | 1100 MEDICAL CENTER PARKWAY, SELMA, AL, 36701 |
Signature of
| Role | Plan administrator |
| Date | 2022-02-19 |
| Name of individual signing | DAE SONG |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-12-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348748787 |
| Plan sponsor’s address | 1100 MEDICAL CENTER PARKWAY, SELMA, AL, 36701 |
Signature of
| Role | Plan administrator |
| Date | 2021-02-15 |
| Name of individual signing | DAE SONG |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-12-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348748787 |
| Plan sponsor’s address | 1100 MEDICAL CENTER PARKWAY, SELMA, AL, 36701 |
Signature of
| Role | Plan administrator |
| Date | 2020-01-29 |
| Name of individual signing | DAE SONG |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-12-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348748787 |
| Plan sponsor’s address | 1100 MEDICAL CENTER PARKWAY, SELMA, AL, 36701 |
Signature of
| Role | Plan administrator |
| Date | 2019-02-12 |
| Name of individual signing | DAE SONG |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2002-12-01 |
| Business code | 621111 |
| Sponsor’s telephone number | 3348748787 |
| Plan sponsor’s address | 1100 MEDICAL CENTER PARKWAY, SELMA, AL, 36701 |
Signature of
| Role | Plan administrator |
| Date | 2018-05-11 |
| Name of individual signing | DAE SONG |
| Name | Role | Address |
|---|---|---|
| SONG, DAE | Incorporator | 10011 KODIAK DRIVEHUNTSVILLE, AL 35803 |
| Name | Role | Address |
|---|---|---|
| SONG, DAE | Agent | 10011 KODIAK DRIVEHUNTSVILLE, AL 35803 |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
