| Name: | Alabama Retina Specialists, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 03 Sep 2004 (20 years ago) (Companies founded in September 2004) |
| Entity Number: | 000-237-404 |
| Register Number: | 000237404 |
| ZIP code: | 36604 (Companies in Mobile, 36604) |
| County: | Mobile |
| Place of Formation: | Baldwin County |
| Registered Office Street Address: | 2 NORTH JACKSON ST., SUITE 605MONTGOMERY, AL 36104 |
| Principal Address: | 3290 DAUPHIN ST STE 401MOBILE, AL 36604 |
| Authorized Capital: | $10 |
Activities
MEDICAL PRACTICE
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1366526691 | 2006-10-24 | 2008-06-11 | 250 STATE FARM PKWY, BIRMINGHAM, AL, 352097181, US | 3290 DAUPHIN ST, SUITE 401, MOBILE, AL, 366064062, US | |||||||||||||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||||||||||||||||
| Phone | +1 205-943-4600 |
| Fax | 2059434688 |
| Phone | +1 251-471-3309 |
| Fax | 2514715046 |
Authorized person
| Name | DR. SUNIL GUPTA |
| Role | PRESIDENT/OWNER |
| Phone | 2514713309 |
Taxonomy
| Taxonomy Code | 207W00000X - Ophthalmology Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1366526691 |
| State | AL |
| Issuer | MEDICAID |
| Number | 529922010 |
| State | AL |
| Issuer | RR MEDICARE PGBA |
| Number | DD0537 |
| State | AL |
| Name | Role | Address |
|---|---|---|
| C T CORPORATION SYSTEM | Agent | 2 NORHT JACKSON STREET SUITE 605MONTGOMERY, AL 36104 |
| Name | Role |
|---|---|
| JESMONTH, RICHARD E | Incorporator |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
