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  5. KLIBANOFF EYE ASSOCIATES, LTD.

KLIBANOFF EYE ASSOCIATES, LTD.

Company Details

Name: KLIBANOFF EYE ASSOCIATES, LTD.
Jurisdiction: Rhode Island
Entity type: Domestic Profit Corporation
Status: Activ
Date of Organization in Rhode Island: 07 Jan 1980 (45 years ago)
Identification Number: 000015660
ZIP code: 02860
County: Providence County
Principal Address: 55 BROAD STREET, PAWTUCKET, RI, 02860, USA
Purpose: PRACTICE OF OPTOMETRY
NAICS: 621320 - Offices of Optometrists
Historical names: DR. DAVID A. KLIBANOFF and DR. MAX KLIBANOFF, LTD.
PAWTUCKET EYE ASSOCIATES, LTD.

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1528373743 2010-08-12 2010-08-12 121 BROAD ST, PAWTUCKET, RI, 028602053, US 121 BROAD ST, PAWTUCKET, RI, 028602053, US

Contacts
Phone +1 401-723-3400

Authorized person
Name DR. DAVID KLIBANOFF
Role PRESIDENT
Phone 4017233400

Taxonomy
Taxonomy Code 152W00000X - Optometrist
License Number CODTG00551
State RI
Is Primary Yes

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
KLIBANOFF EYE ASSOCIATES, LTD. 401(K) PROFIT SHARING PLAN 2023 050384813 2024-04-05 KLIBANOFF EYE ASSOCIATES, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2024-04-05
Name of individual signing BENJAMIN KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. 401(K) PROFIT SHARING PLAN 2022 050384813 2023-06-07 KLIBANOFF EYE ASSOCIATES, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2023-06-07
Name of individual signing BENJAMIN KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. 401(K) PROFIT SHARING PLAN 2021 050384813 2022-02-24 KLIBANOFF EYE ASSOCIATES, LTD. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2022-02-24
Name of individual signing BENJAMIN KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. 401(K) PROFIT SHARING PLAN 2020 050384813 2021-06-22 KLIBANOFF EYE ASSOCIATES, LTD. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2021-06-22
Name of individual signing BENJAMIN KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. 401(K) PROFIT SHARING PLAN 2019 050384813 2020-04-08 KLIBANOFF EYE ASSOCIATES, LTD. 12
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2020-04-08
Name of individual signing BENJAMIN KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. 401(K) PROFIT SHARING PLAN 2018 050384813 2019-04-03 KLIBANOFF EYE ASSOCIATES, LTD. 13
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2019-04-03
Name of individual signing BENJAMIN KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. PROFIT SHARING PLAN 2017 050384813 2018-07-26 KLIBANOFF EYE ASSOCIATES, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2018-07-26
Name of individual signing BENJAMIN KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. PROFIT SHARING PLAN 2016 050384813 2017-05-16 KLIBANOFF EYE ASSOCIATES, LTD. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2017-05-16
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. PROFIT SHARING PLAN 2015 050384813 2016-03-30 KLIBANOFF EYE ASSOCIATES, LTD. 15
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2016-03-30
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
KLIBANOFF EYE ASSOCIATES, LTD. PROFIT SHARING PLAN 2014 050384813 2015-10-07 KLIBANOFF EYE ASSOCIATES, LTD. 14
File View Page
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2015-10-07
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/23/20140923133948P030015589111001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Signature of
Role Plan administrator
Date 2014-09-23
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/07/02/20130702085506P040101247989001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050384813
Plan administrator’s name KLIBANOFF EYE ASSOCIATES, LTD.
Plan administrator’s address 55 BROAD STREET, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017233400

Signature of
Role Plan administrator
Date 2013-07-02
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/09/28/20120928121826P030004413205001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 55 BROAD STREET, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050384813
Plan administrator’s name KLIBANOFF EYE ASSOCIATES, LTD.
Plan administrator’s address 55 BROAD STREET, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017233400

Signature of
Role Plan administrator
Date 2012-09-28
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/28/20110728124635P040033036967001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 121 BROAD STREET, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050384813
Plan administrator’s name KLIBANOFF EYE ASSOCIATES, LTD.
Plan administrator’s address 121 BROAD STREET, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017233400

Signature of
Role Plan administrator
Date 2011-07-28
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/28/20110728131246P040474461568001.pdf
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 121 BROAD STREET, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050384813
Plan administrator’s name KLIBANOFF EYE ASSOCIATES, LTD.
Plan administrator’s address 121 BROAD STREET, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017233400

Signature of
Role Plan administrator
Date 2011-07-28
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 001
Effective date of plan 1995-01-01
Business code 621320
Sponsor’s telephone number 4017233400
Plan sponsor’s address 121 BROAD STREET, PAWTUCKET, RI, 02860

Plan administrator’s name and address
Administrator’s EIN 050384813
Plan administrator’s name KLIBANOFF EYE ASSOCIATES, LTD.
Plan administrator’s address 121 BROAD STREET, PAWTUCKET, RI, 02860
Administrator’s telephone number 4017233400

Signature of
Role Plan administrator
Date 2010-09-30
Name of individual signing DAVID KLIBANOFF
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DAVID A. KLIBANOFF Agent 55 BROAD STREET, PAWTUCKET, RI, 02860, USA

PRESIDENT

Name Role Address
BENJAMIN D KLIBANOFF PRESIDENT 55 BROAD STREET PAWTUCKET, RI 02860 USA

TREASURER

Name Role Address
BENJAMIN D KLIBANOFF TREASURER 55 BROAD STREET PAWTUCKET, RI 02860 USA

SECRETARY

Name Role Address
BENJAMIN D KLIBANOFF SECRETARY 55 BROAD STREET PAWTUCKET, RI 02860 USA

VICE PRESIDENT

Name Role Address
BENJAMIN D. KLIBANOFF VICE PRESIDENT 55 BROAD STREET PAWTUCKET, RI 02860 USA

Events

Type Date Old Value New Value
Name Change 1989-10-11 PAWTUCKET EYE ASSOCIATES, LTD. KLIBANOFF EYE ASSOCIATES, LTD.
Name Change 1980-06-10 DR. DAVID A. KLIBANOFF and DR. MAX KLIBANOFF, LTD. PAWTUCKET EYE ASSOCIATES, LTD.

Filings

Number Name File Date
202449014820 Annual Report 2024-03-21
202327464840 Annual Report 2023-02-03
202208643980 Annual Report 2022-01-26
202186001310 Annual Report 2021-01-13
202033372400 Annual Report 2020-01-30
201985323300 Annual Report 2019-01-29
201855915460 Annual Report 2018-01-10
201748388300 Annual Report 2017-08-11
201747692930 Revocation Notice For Failure to File An Annual Report 2017-07-27
201690241960 Annual Report 2016-01-08

Related by officers

DAVID A. KLIBANOFF

AIR AMBULANCE AND CHARTER, LTD.

Related by address

55 BROAD STREET, PAWTUCKET, RI, 02860, USA

ACUITY PROPERTIES, LLC

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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