| Name: | Cullman Eye Specialists, P.C. |
| Jurisdiction: | Alabama |
| Legal type: | Domestic Professional Corporation |
| Status: | Exists |
| Date of registration: | 15 Dec 2005 (19 years ago) |
| Entity Number: | 000-244-749 |
| Register Number: | 000244749 |
| County: | Cullman |
| Place of Formation: | Cullman County |
| Principal Address: | CULLMAN, AL |
| Registered Office Street Address: | 1400 WALL STREET NECULLMAN, AL 35055 |
| Registered Office Street Address ZIP Code: | 35055 |
| Authorized Capital: | $5,000 |
Activities
PRACTICE OF OPTOMETRY
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1407957368 | 2006-09-25 | 2013-02-11 | 601 GRAHAM STREET SW, SUITE B, CULLMAN, AL, 350555298, US | 601 GRAHAM STREET SW, SUITE B, CULLMAN, AL, 350555298, US | |||||||||||||||||||||||||
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| Phone | +1 256-734-8514 |
| Fax | 2567348392 |
Authorized person
| Name | DR. EMILY CHE' FLORES |
| Role | PRESIDENT |
| Phone | 2567348514 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | S-A13-TA-594 |
| State | AL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 529927530 |
| State | AL |
| Plan Name | Plan Year | EIN/PN | Received | Sponsor | Total number of participants | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CULLMAN EYE SPECIALISTS, P. C. 401(K) PLAN | 2017 | 203956293 | 2018-05-16 | CULLMAN EYE SPECIALISTS, P.C. | 7 | |||||||||||||||||||||
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| CULLMAN EYE SPECIALISTS, P. C. 401(K) PLAN | 2016 | 203956293 | 2017-07-27 | CULLMAN EYE SPECIALISTS, P.C. | 6 | |||||||||||||||||||||
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| Role | Plan administrator |
| Date | 2017-07-27 |
| Name of individual signing | EMILY FLORES |
| File | View Page |
| Three-digit plan number (PN) | 001 |
| Effective date of plan | 2015-01-01 |
| Business code | 621320 |
| Sponsor’s telephone number | 2567348514 |
| Plan sponsor’s address | 601-B GRAHAM STREET SW, CULLMAN, AL, 350555298 |
Signature of
| Role | Plan administrator |
| Date | 2016-06-30 |
| Name of individual signing | EMILY FLORES |
| Name | Role | Address |
|---|---|---|
| FLORES, EMILY C | Agent | 601-A GRAHAM STREETCULLMAN, AL 35055 |
| Name | Role | Address |
|---|---|---|
| FLORES, EMILY C | Incorporator | 601-A GRAHAM STREETCULLMAN, AL 35055 |
Date of last update: 02 Aug 2024
Sources: Alabama Secretary of State
