| Name: | Oak Mountain Eye Care, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 13 Oct 2000 (24 years ago) (Companies founded in October 2000) |
| Entity Number: | 000-212-744 |
| Register Number: | 000212744 |
| ZIP code: | 35242 (Companies in Shelby, 35242) |
| County: | Shelby |
| Place of Formation: | Shelby County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 4960 VALLEYDALE RDBIRMINGHAM, AL 35242 |
| Authorized Capital: | $1,000 |
Activities
PROVIDE EYE CARE MEDICAL SERVICES/SELL/SERVICE EYE CARE PRODUCTS
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1255316006 | 2005-12-14 | 2012-02-21 | 4960 VALLEYDALE RD, SUITE 201, BIRMINGHAM, AL, 352424613, US | 4960 VALLEYDALE RD, SUITE 201, BIRMINGHAM, AL, 352424613, US | |||||||||||||||||||||||||||||
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| Phone | +1 205-980-5152 |
| Fax | 2059805154 |
Authorized person
| Name | DR. MICHAEL D BLACKBURN |
| Role | PRESIDENT OWNER |
| Phone | 2059805152 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S672TA330 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BLUE CROSS BLUE SHIELD |
| Number | 51500011 |
| State | AL |
| Issuer | RAILROAD MEDICARE |
| Number | P00105638 |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| OAK MOUNTAIN EYE CARE P C 401(K) PROFIT SHARING PLAN & TRUST | 2023 | 631260941 | 2024-06-26 | OAK MOUNTAIN EYE CARE P C | 7 | |||||||||||||||||||||
|
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| Role | Plan administrator |
| Date | 2024-06-26 |
| Name of individual signing | MICHAEL D BLACKBURN |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 621320 |
| Sponsor’s telephone number | 2059805152 |
| Plan sponsor’s address | 4960 VALLEYDALE RD STE 201, BIRMINGHAM, AL, 35242 |
Signature of
| Role | Plan administrator |
| Date | 2023-04-06 |
| Name of individual signing | EDWARD ROJAS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 621320 |
| Sponsor’s telephone number | 2059805152 |
| Plan sponsor’s address | 4960 VALLEYDALE RD STE 201, BIRMINGHAM, AL, 35242 |
Signature of
| Role | Plan administrator |
| Date | 2022-04-27 |
| Name of individual signing | EDWARD ROJAS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 621320 |
| Sponsor’s telephone number | 2059805152 |
| Plan sponsor’s address | 4960 VALLEYDALE RD STE 201, BIRMINGHAM, AL, 35242 |
Signature of
| Role | Plan administrator |
| Date | 2021-04-06 |
| Name of individual signing | EDWARD ROJAS |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2019-01-01 |
| Business code | 621320 |
| Sponsor’s telephone number | 2059805152 |
| Plan sponsor’s address | 4960 VALLEYDALE RD STE 201, BIRMINGHAM, AL, 35242 |
Signature of
| Role | Plan administrator |
| Date | 2020-05-21 |
| Name of individual signing | EDWARD ROJAS |
| Name | Role |
|---|---|
| BLACKBURN, MICHAEL D | Agent |
| Name | Role |
|---|---|
| BLACKBURN, MICHAEL D | Incorporator |
Date of last update: 01 Aug 2024
Sources: Alabama Secretary of State
