| Name: | Dr. John T. Keriotis & Associates, Inc. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Corporation |
| Status: | Dissolved |
| Date of registration: | 24 Apr 2002 (23 years ago) |
| Date of dissolution: | 23 Mar 2021 |
| Entity Number: | 000-222-574 |
| Register Number: | 000222574 |
| County: | Jefferson |
| Place of Formation: | Jefferson County |
| Principal Address: | BIRMINGHAM, AL |
| Registered Office Street Address: | 3612 VICKSBURG DRBIRMINGHAM, AL 35213 |
| Registered Office Street Address ZIP Code: | 35213 |
| Authorized Capital: | 1,000 |
Activities
PRACTICE OPTOMETRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1689890410 | 2007-04-18 | 2016-11-03 | 1115 LAKE COLONY LN, BIRMINGHAM, AL, 352427422, US | 790 MONTGOMERY HWY, SUITE 110, VESTAVIA, AL, 352161872, US | |||||||||||||||||||||||||
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| Phone | +1 205-979-3937 |
| Fax | 2058243937 |
Authorized person
| Name | DR. JOHN KERIOTIS |
| Role | PRESIDENT |
| Phone | 2055862786 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S-710-TA-549 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 051515567 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR. JOHN T. KERIOTIS & ASSOCIATES 401K PLAN | 2012 | 010629791 | 2013-10-09 | DR. JOHN T. KERIOTIS & ASSOCIATES INC | 1 | |||||||||||||||||||||||||||
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| Administrator’s EIN | 010629791 |
| Plan administrator’s name | JOHN T. KERIOTIS |
| Administrator’s telephone number | 2059793937 |
Signature of
| Role | Plan administrator |
| Date | 2013-10-09 |
| Name of individual signing | ANGELA BROTHERS |
| Name | Role |
|---|---|
| KERIOTIS, JOHN T II | Agent |
| Name | Role |
|---|---|
| KERIOTIS, JOHN T II | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
