| Name: | Dothan Ophthalmology, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Dissolved |
| Date of registration: | 17 Feb 2004 (21 years ago) |
| Date of dissolution: | 15 Dec 2021 |
| Entity Number: | 000-233-665 |
| Register Number: | 000233665 |
| Historical Names: |
Pediatric Ophthalmology & Adult Strabismus, P.C.
|
| County: | Houston |
| Place of Formation: | Houston County |
| Principal Address: | DOTHAN, AL |
| Registered Office Street Address: | 4300 W MAIN ST STE 102DOTHAN, AL 36301 |
| Registered Office Street Address ZIP Code: | 36301 |
| Authorized Capital: | $1,200 |
Activities
PEDIATRIC OPHTHALMOLOGY/ADULT STRABISMUS PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1467511626 | 2006-12-06 | 2019-06-17 | 1750 W MAIN ST, DOTHAN, AL, 363011318, US | 1750 W MAIN ST, DOTHAN, AL, 363011318, US | |||||||||||||||||||||||||||||||||||||
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| Phone | +1 334-793-1070 |
| Fax | 3347935114 |
Authorized person
| Name | DR. JOSEPH H SUGG JR. |
| Role | PRESIDENT |
| Phone | 3347931070 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| License Number | 25880 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | BCBS |
| Number | 51521882 |
| State | AL |
| Issuer | MEDICAID |
| Number | 051554697 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529920110 |
| State | AL |
| Name | Role |
|---|---|
| SUGG, JOSEPH H JR | Agent |
| Name | Role | Address |
|---|---|---|
| MCNAB, F MITCH | Incorporator | 200 PARKWEST CIRCLE SUITE 2DOTHAN, AL 36303 |
| Event Date | Event Type | Old Value | New Value |
|---|---|---|---|
| 2006-06-13 | Name Change | Pediatric Ophthalmology & Adult Strabismus, P.C. | Dothan Ophthalmology, P.C. |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
