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Florence Ophthalmology, LLC

Details

Name: Florence Ophthalmology, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 29 May 2002 (22 years ago) (Companies founded in May 2002)
Entity Number: 000-223-162
Register Number: 000223162
Historical Names: Florence Ophthalmology, P.C.
ZIP code: 36104 (Companies in Montgomery, 36104)
County: Montgomery
Place of Formation: Lauderdale County
Registered Office Street Address: 2 NORTH JACKSON STREET, SUITE 605MONTGOMERY, AL 36104

Activities OPHTHALMOLOGY PROFESSION

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1932314473 2007-05-10 2019-12-19 646 COX CREEK PKWY STE A, FLORENCE, AL, 356301105, US 646 COX CREEK PKWY STE A, FLORENCE, AL, 356301189, US

Contacts
Phone +1 256-760-9149
Fax 2567609149
Phone +1 256-760-1771
Fax 2567664713

Authorized person
Name MRS. JACKIE A GROSS
Role OFFICE ADMINISTRATOR
Phone 2567601771

Taxonomy
Taxonomy Code 207W00000X - Ophthalmology Physician
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
FLORENCE OPHTHALMOLOGY, P.C. 401(K) PLAN 2012 043663311 2013-09-17 FLORENCE OPHTHALMOLOGY, P.C. 21
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630

Signature of
Role Plan administrator
Date 2013-09-17
Name of individual signing MICHAEL BRUMMITT, MD
FLORENCE OPHTHALMOLOGY, P.C. 401(K) PLAN 2012 043663311 2013-06-19 FLORENCE OPHTHALMOLOGY, P.C. 21
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630

Signature of
Role Plan administrator
Date 2013-06-19
Name of individual signing MICHAEL BRUMMITT, MD
FLORENCE OPHTHALMOLOGY, P.C. 401(K) PLAN 2011 043663311 2012-06-13 FLORENCE OPHTHALMOLOGY, P.C. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630

Plan administrator’s name and address
Administrator’s EIN 043663311
Plan administrator’s name FLORENCE OPHTHALMOLOGY, P.C.
Plan administrator’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630
Administrator’s telephone number 2567601771

Signature of
Role Plan administrator
Date 2012-06-13
Name of individual signing FLORENCE OPTHMAOLOGY
FLORENCE OPHTHALMOLOGY, PC 401(K) PROFIT SHARING PLAN 2011 043663311 2013-06-20 FLORENCE OPHTHALMOLOGY, P.C. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, STE. A, FLORENCE, AL, 35630

Plan administrator’s name and address
Administrator’s EIN 043663311
Plan administrator’s name FLORENCE OPHTHALMOLOGY, P.C.
Plan administrator’s address 646 COX CREEK PARKWAY, STE. A, FLORENCE, AL, 35630
Administrator’s telephone number 2567601771

Signature of
Role Plan administrator
Date 2013-06-20
Name of individual signing MICHAEL BRUMMITT, MD
FLORENCE OPHTHALMOLOGY, P.C. 401(K) PROFIT SHARIN PLAN 2010 043663311 2013-06-20 FLORENCE OPHTHALMOLOGY, P.C. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, STE. A, FLORENCE, AL, 35630

Plan administrator’s name and address
Administrator’s EIN 043663311
Plan administrator’s name FLORENCE OPHTHALMOLOGY, P.C.
Plan administrator’s address 646 COX CREEK PARKWAY, STE. A, FLORENCE, AL, 35630
Administrator’s telephone number 2567601771

Signature of
Role Plan administrator
Date 2013-06-20
Name of individual signing MICHAEL BUMMITT, M.D.
FLORENCE OPHTHALMOLOGY, P.C. 401(K) PLAN 2010 043663311 2011-04-01 FLORENCE OPHTHALMOLOGY, P.C. 23
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630

Plan administrator’s name and address
Administrator’s EIN 043663311
Plan administrator’s name FLORENCE OPHTHALMOLOGY, P.C.
Plan administrator’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630
Administrator’s telephone number 2567601771

Signature of
Role Plan administrator
Date 2011-04-01
Name of individual signing FLORENCE OPTHMAOLOGY
FLORENCE OPHTHALMOLOGY, P.C. 401(K) PLAN 2009 043663311 2010-10-28 FLORENCE OPHTHALMOLOGY, P.C. 22
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630

Plan administrator’s name and address
Administrator’s EIN 043663311
Plan administrator’s name FLORENCE OPHTHALMOLOGY, P.C.
Plan administrator’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630
Administrator’s telephone number 2567601771

Signature of
Role Plan administrator
Date 2010-10-28
Name of individual signing FLORENCE OPTHMAOLOGY
FLORENCE OPHTHALMOLOGY, P.C. 401(K) PLAN 2009 043663311 2010-10-15 FLORENCE OPHTHALMOLOGY, P.C. 22
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630

Plan administrator’s name and address
Administrator’s EIN 043663311
Plan administrator’s name FLORENCE OPHTHALMOLOGY, P.C.
Plan administrator’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630
Administrator’s telephone number 2567601771

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing FRANK HARRISON
FLORENCE OPHTHALMOLOGY, P.C. 401(K) PLAN 2009 043663311 2010-10-14 FLORENCE OPHTHALMOLOGY, P.C. 22
Three-digit plan number (PN) 001
Effective date of plan 2003-01-01
Business code 621111
Sponsor’s telephone number 2567601771
Plan sponsor’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630

Plan administrator’s name and address
Administrator’s EIN 043663311
Plan administrator’s name FLORENCE OPHTHALMOLOGY, P.C.
Plan administrator’s address 646 COX CREEK PARKWAY, FLORENCE, AL, 35630
Administrator’s telephone number 2567601771

Signature of
Role Plan administrator
Date 2010-10-14
Name of individual signing FRANK HARRISON

Agent

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

Events

Event Date Event Type Old Value New Value
2019-09-11 Name Change Florence Ophthalmology, P.C. Florence Ophthalmology, LLC

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Date of last update: 02 Aug 2024

Sources: Alabama Secretary of State

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