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Andalusia Eye Clinic, LLC

Details

Name: Andalusia Eye Clinic, LLC
Jurisdiction: Alabama
Legal type: Domestic Limited Liability Company
Status: Exists
Date of registration: 08 Sep 2005 (19 years ago)
Entity Number: 000-468-562
Register Number: 000468562
County: Covington
Place of Formation: Covington County
Principal Address: ANDALUSIA, AL
Registered Office Street Address: 1860 EAST THREE NOTCH STANDALUSIA, AL 36420
Registered Office Street Address ZIP Code: 36420

Activities EYE CARE SERVICES

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1629133111 2006-12-26 2015-08-17 PO BOX 1517, ANDALUSIA, AL, 364201226, US 1860 E THREE NOTCH ST, ANDALUSIA, AL, 364212404, US

Contacts
Phone +1 334-222-2020

Authorized person
Name DR. JAMES H TILLMAN JR.
Role OWNER
Phone 3342222020

Taxonomy
Taxonomy Code 152W00000X - Optometrist
License Number S620TA088
State AL
Is Primary Yes
Taxonomy Code 207W00000X - Ophthalmology Physician
License Number 00025149
State AL
Is Primary No

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2023 203426591 2024-10-10 ANDALUSIA EYE CLINIC, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342222020
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2024-10-10
Name of individual signing JAMES H. TILLMAN, JR.
Valid signature Filed with authorized/valid electronic signature
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2022 203426591 2023-10-05 ANDALUSIA EYE CLINIC, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342222020
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2023-10-05
Name of individual signing JAMES H. TILLMAN, JR.
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2021 203426591 2022-10-11 ANDALUSIA EYE CLINIC, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342222020
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2022-10-11
Name of individual signing JAMES H. TILLMAN, JR.
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2020 203426591 2021-09-20 ANDALUSIA EYE CLINIC, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342222020
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2021-09-20
Name of individual signing JAMES H. TILLMAN, JR.
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2019 203426591 2020-11-17 ANDALUSIA EYE CLINIC, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342222020
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2020-11-17
Name of individual signing JAMES H. TILLMAN, JR.
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2018 203426591 2019-10-07 ANDALUSIA EYE CLINIC, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342222020
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2019-10-07
Name of individual signing JAMES H. TILLMAN, JR.
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2017 203426591 2018-10-15 ANDALUSIA EYE CLINIC, LLC 9
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342224678
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2018-10-15
Name of individual signing JAMES H. TILLMAN, JR.
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2016 203426591 2018-01-29 ANDALUSIA EYE CLINIC, LLC 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342224678
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2018-01-29
Name of individual signing JAMES H. TILLMAN, JR.
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2015 203426591 2016-09-21 ANDALUSIA EYE CLINIC, LLC 11
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342224678
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2016-09-21
Name of individual signing JAMES H. TILLMAN, JR.
ANDALUSIA EYE CLINIC, LLC SAFE HARBOR 401(K) PLAN 2014 203426591 2015-10-08 ANDALUSIA EYE CLINIC, LLC 10
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-01-01
Business code 621111
Sponsor’s telephone number 3342224678
Plan sponsor’s address P.O. BOX 1517, ANDALUSIA, AL, 36420

Signature of
Role Plan administrator
Date 2015-10-08
Name of individual signing JAMES H. TILLMAN, JR.

Agent

Name Role
TILLMAN, J H JR Agent

Member

Name Role
TILLMAN, J H JR Member

Related by officers

TILLMAN, J H JR

Ocean Point Places, L.L.C. Cashel Properties, LLC

Related by address

ANDALUSIA, AL

Andalusia Development Company Andalusia Farmers Cooperative, Inc. Andalusia Manufacturing Co. Andy Electric Company Benson & Co., Inc. Briarhills Stables, Inc. City Drug Store, Inc. Clark Trailer Service, Inc. Club Apartments, Inc. First Alabama Bank of Covington County

Date of last update: 14 Aug 2024

Sources: Alabama Secretary of State

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