| Name: | MANDALAY OPTICAL LABS, LLC |
| Jurisdiction: | Rhode Island |
| Entity type: | Domestic Limited Liability Company |
| Status: | Activ |
| Date of Organization in Rhode Island: | 11 Jan 2011 (14 years ago) |
| Identification Number: | 000571968 |
| ZIP code: | 02903 |
| County: | Providence County |
| Principal Address: | 891 WESTMINSTER STREET, PROVIDENCE, RI, 02903, USA |
| Purpose: | OPTICAL LAB |
| NAICS: | 446130 - Optical Goods Stores |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1396251740 | 2017-12-21 | 2017-12-21 | 905 WESTMINSTER ST, PROVIDENCE, RI, 029034020, US | 905 WESTMINSTER ST, PROVIDENCE, RI, 029034020, US | |||||||||||||||||||||||||
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| Phone | +1 401-331-7850 |
| Fax | 4013317850 |
Authorized person
| Name | SCOTT A COLONNA |
| Role | MANAGER |
| Phone | 4013317850 |
Taxonomy
| Taxonomy Code | 152W00000X - Optometrist |
| License Number | ODTA00491 |
| State | RI |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1538169784 |
| State | RI |
| Name | Role | Address |
|---|---|---|
| LOUIS A. DEQUATTRO, JR., ESQ. | Agent | 1417 DOUGLAS AVENUE, NORTH PROVIDENCE, RI, 02904, USA |
| Number | Name | File Date |
|---|---|---|
| 202455203900 | Annual Report | 2024-06-01 |
| 202335071740 | Annual Report | 2023-05-02 |
| 202218034820 | Annual Report | 2022-05-31 |
| 202105578790 | Annual Report | 2021-11-30 |
| 202077961950 | Annual Report | 2020-11-30 |
| 201928967770 | Statement of Change of Registered/Resident Agent Office | 2019-12-02 |
| 201928473820 | Annual Report | 2019-11-29 |
| 201879891520 | Annual Report | 2018-10-22 |
| 201879896660 | Articles of Amendment | 2018-10-22 |
| 201855524950 | Annual Report - Amended | 2018-01-02 |
Date of last update: 15 Oct 2024
Sources: Rhode Island Department of State
