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IDAHO EYELID & FACIAL PLASTIC SURGERY, PLLC

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Company Details

Name: IDAHO EYELID & FACIAL PLASTIC SURGERY, PLLC
Jurisdiction: Idaho
Legal type: Limited Liability Company (D)
Status: Active-Existing
Date of registration: 12 Apr 2005 (20 years ago)
Financial Date End: 30 Apr 2025
Entity Number: 128040
Place of Formation: IDAHO
File Number: 128040
ZIP code: 83702
County: Ada County
Principal Address: 111 W. MAIN ST 200 BOISE, ID 83702
Mailing Address: STE 200 111 W MAIN ST BOISE, ID 83702-7308

Agent

Name Role Address
DR MARK BOERNER Agent 111 W. MAIN ST, STE 200, BOISE, ID 83702

Member

Name Role Address Appointed On Resigned On
Mark J Boerner MD Member 111 W MAIN ST, BOISE, ID 83702-7308 2023-04-10 No data
Mark Boerner Member 111 W MAIN ST. STE 200, BOISE, ID 83702 2021-08-30 2023-04-10

Manager

Name Role Address Appointed On
Ashley L Gulley Manager 111 W MAIN ST, BOISE, ID 83702-7308 2024-04-25

National Provider Identifier

NPI Number:
1255401436
Certification Date:
2020-04-03

Authorized Person:

Name:
DR. MARK J BOERNER
Role:
OWNER
Phone:

Taxonomy:

Selected Taxonomy:
152W00000X - Optometrist
Is Primary:
No
Selected Taxonomy:
207W00000X - Ophthalmology Physician
Is Primary:
Yes

Contacts:

Fax:
2083440461

Filing

Filing Name Filing Number Filing date
Annual Report 0005704212 2024-04-25
Application for Reinstatement 0005193216 2023-04-10
Dissolution/Revocation - Administrative 0004810737 2022-07-09
Application for Reinstatement 0004395390 2021-08-30
Dissolution/Revocation - Administrative 0004347051 2021-07-14

USAspending Awards / Financial Assistance

Date:
2020-04-11
Awarding Agency Name:
Small Business Administration
Transaction Description:
TO AID SMALL BUSINESSES IN MAINTAINING WORK FORCE DURING COVID-19 PANDEMIC.
Obligated Amount:
0.00
Face Value Of Loan:
102300.00
Total Face Value Of Loan:
102300.00

Paycheck Protection Program

Jobs Reported:
9
Initial Approval Amount:
$102,300
Date Approved:
2020-04-11
Loan Status:
Paid in Full
SBA Guaranty Percentage:
100
Current Approval Amount:
$102,300
Race:
Unanswered
Ethnicity:
Unknown/NotStated
Gender:
Unanswered
Veteran:
Unanswered
Forgiveness Amount:
$103,258.54
Servicing Lender:
D. L. Evans Bank
Use of Proceeds:
Payroll: $76,725
Utilities: $12,787.5
Rent: $12,787.5

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Date of last update: 24 Jun 2025

Sources: Idaho Secretary of State