ELLIOTT M SHAPIRO OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****25

License Status

CANCELLED

Business

First Name

ELLIOTT

Middle

Last Name

SHAPIRO

Suffix

Business Name

ELLIOTT M SHAPIRO OD

Original Issue Date

05/30/1996

Effective Date

04/01/2004

Expiration Date

03/31/2006

City

SAN DIEGO

State

Zip

92130

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006