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  5. RETINA CONSULTANTS, INC.

RETINA CONSULTANTS, INC.

Company Details

Name: RETINA CONSULTANTS, INC.
Jurisdiction: Rhode Island
Entity type: Professional Service Corporation
Status: Revoked Entity
Date of Organization in Rhode Island: 29 Dec 1978 (46 years ago)
Date of Dissolution: 17 Sep 2024 (5 months ago)
Date of Status Change: 17 Sep 2024 (5 months ago)
Identification Number: 000019283
ZIP code: 02903
County: Providence County
Principal Address: 101 PLAIN STREET SUITE 101, PROVIDENCE, RI, 02903, USA
Purpose: MEDICAL PRACTICE
NAICS: 622110 - General Medical and Surgical Hospitals

National Provider Identifier

NPI Enumeration Date Last Update Date Mailing Address Practice Location Address
1780765354 2006-10-18 2020-07-21 101 PLAIN ST STE 101, PROVIDENCE, RI, 029034828, US 101 PLAIN ST STE 101, PROVIDENCE, RI, 029034828, US

Contacts
Phone +1 401-274-5844
Fax 4012749462

Authorized person
Name EDWINA L REGO
Role MANAGER
Phone 4012745844

Taxonomy
Taxonomy Code 207W00000X - Ophthalmology Physician
Is Primary No
Taxonomy Code 207WX0107X - Retina Specialist (Ophthalmology) Physician
Is Primary Yes

Other Provider Identifiers
Issuer MEDICAID
Number 9729321
State MA
Issuer MEDICAID
Number RC01092
State RI

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
RETINA CONSULTANTS INC 401(K) PROFIT SHARING PLAN & TRUST 2023 050380297 2024-07-30 RETINA CONSULTANTS INC 20
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012746991
Plan sponsor’s address 101 PLAIN ST, STE 1, PROVIDENCE, RI, 029034829

Signature of
Role Plan administrator
Date 2024-07-30
Name of individual signing EDWINA REGO
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS INC 401(K) PROFIT SHARING PLAN & TRUST 2022 050380297 2023-07-26 RETINA CONSULTANTS INC 20
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012746991
Plan sponsor’s address 101 PLAIN ST, STE 1, PROVIDENCE, RI, 029034829

Signature of
Role Plan administrator
Date 2023-07-26
Name of individual signing EDWINA REGO
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS INC 401(K) PROFIT SHARING PLAN & TRUST 2021 050380297 2022-06-20 RETINA CONSULTANTS INC 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012746991
Plan sponsor’s address 101 PLAIN ST, STE 1, PROVIDENCE, RI, 029034829

Signature of
Role Plan administrator
Date 2022-06-20
Name of individual signing EDWINA REGO
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS INC 401(K) PROFIT SHARING PLAN & TRUST 2020 050380297 2021-08-02 RETINA CONSULTANTS INC 16
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012746991
Plan sponsor’s address 101 PLAIN ST STE 1, PROVIDENCE, RI, 029034829

Signature of
Role Plan administrator
Date 2021-08-02
Name of individual signing EDWINA REGO
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS INC 401(K) PROFIT SHARING PLAN & TRUST 2019 050380297 2020-05-13 RETINA CONSULTANTS INC 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012746991
Plan sponsor’s address 101 PLAIN ST STE 1, PROVIDENCE, RI, 029034829

Signature of
Role Plan administrator
Date 2020-05-13
Name of individual signing EDWINA REGO
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS INC 401 K PROFIT SHARING PLAN TRUST 2018 050380297 2019-10-15 RETINA CONSULTANTS INC. 17
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012746991
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2019-10-15
Name of individual signing EDWINA REGP
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS INC 401 K PROFIT SHARING PLAN TRUST 2018 050380297 2019-10-11 RETINA CONSULTANTS INC. 17
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012746991
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2019-10-11
Name of individual signing EDWINA REGO
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS, INC. 401(K)PROFIT SHARING PLAN 2017 050380297 2018-06-18 RETINA CONSULTANTS, INC. 19
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2018-06-18
Name of individual signing HAROLD WOODCOME JR
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS, INC. 401(K)PROFIT SHARING PLAN 2016 050380297 2017-10-05 RETINA CONSULTANTS, INC. 18
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2017-10-05
Name of individual signing HAROLD WOODCOME JR
Valid signature Filed with authorized/valid electronic signature
RETINA CONSULTANTS, INC. 401(K)PROFIT SHARING PLAN 2015 050380297 2016-10-17 RETINA CONSULTANTS, INC. 14
File View Page
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2016-10-17
Name of individual signing HAROLD WOODCOME JR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2015/10/15/20151015071209P040045630327001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2015-10-15
Name of individual signing HAROLD WOODCOME JR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2014/09/29/20140929105048P030008243919001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2014-09-29
Name of individual signing HAROLD WOODCOME JR
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2013/05/13/20130513080644P040215279539001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Signature of
Role Plan administrator
Date 2013-05-13
Name of individual signing HAROLD WOODCOME
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2012/07/16/20120716134410P030005631778001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 02903

Plan administrator’s name and address
Administrator’s EIN 050380297
Plan administrator’s name RETINA CONSULTANTS, INC.
Plan administrator’s address 690 EDDY STREET, PROVIDENCE, RI, 029034928
Administrator’s telephone number 4012745844

Signature of
Role Plan administrator
Date 2012-07-16
Name of individual signing HAROLD WOODCOME
Valid signature Filed with authorized/valid electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2011/07/19/20110719085547P030452425136001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 029034928

Plan administrator’s name and address
Administrator’s EIN 050380297
Plan administrator’s name RETINA CONSULTANTS, INC.
Plan administrator’s address 690 EDDY STREET, PROVIDENCE, RI, 029034928
Administrator’s telephone number 4012745844

Signature of
Role Plan administrator
Date 2011-07-19
Name of individual signing HAROLD WOODCOME
Valid signature Filed with authorized/valid electronic signature
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 029034928

Plan administrator’s name and address
Administrator’s EIN 050380297
Plan administrator’s name RETINA CONSULTANTS, INC.
Plan administrator’s address 690 EDDY STREET, PROVIDENCE, RI, 029034928
Administrator’s telephone number 4012745844

Signature of
Role Plan administrator
Date 2011-07-18
Name of individual signing HAROLD WOODCOME
Valid signature Filed with incorrect/unrecognized electronic signature
File https://efast2-filings-public.s3.amazonaws.com/prd/2010/10/08/20101008125253P040015448897001.pdf
Three-digit plan number (PN) 002
Effective date of plan 1979-01-01
Business code 621111
Sponsor’s telephone number 4012745844
Plan sponsor’s address 690 EDDY STREET, PROVIDENCE, RI, 029034928

Plan administrator’s name and address
Administrator’s EIN 050380297
Plan administrator’s name RETINA CONSULTANTS, INC.
Plan administrator’s address 690 EDDY STREET, PROVIDENCE, RI, 029034928
Administrator’s telephone number 4012745844

Signature of
Role Plan administrator
Date 2010-10-08
Name of individual signing HAROLD WOODCOME
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
DANIEL R. SUMNER Agent 200 METRO CENTER BOULEVARD UNIT 9, WARWICK, RI, 02886, USA

PRESIDENT

Name Role Address
ALTIN PANI PRESIDENT 101 PLAIN STREET, SUITE 101 PROVIDENCE, RI 02903 USA

Filings

Number Name File Date
202459520300 Revocation Certificate For Failure to File the Annual Report for the Year 2024-09-17
202457109110 Revocation Notice For Failure to File An Annual Report 2024-06-25
202335948600 Annual Report 2023-05-22
202214574690 Annual Report 2022-04-07
202195441880 Annual Report 2021-04-02
202031497880 Annual Report 2020-01-08
201989052800 Annual Report 2019-03-21
201861236070 Annual Report 2018-03-30
201731363370 Annual Report 2017-02-02
201695492790 Annual Report 2016-03-31

Related by officers

DANIEL R. SUMNER

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Related by address

No related companies by address

Date of last update: 06 Oct 2024

Sources: Rhode Island Department of State

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