RANDY D FORD OD Optometrist License verification

Business Entity

INACTIVE

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046008158

License Status

INACTIVE

Business

First Name

RANDY

Middle

Last Name

FORD

Suffix

Business Name

RANDY D FORD OD

Original Issue Date

10/22/1988

Effective Date

03/25/2004

Expiration Date

03/31/2006

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

01/18/2006

Case Number

1994001815

Action

Fine

Discipline Start Date

07/01/1995

Discipline Reason

Failed to have ancillary licensed for ten locations.