JEFFERY BLAKE JOHNSON Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST

License Number

046010370

License Status

NOT RENEWED

Business

First Name

JEFFERY

Middle

BLAKE

Last Name

JOHNSON

Business Name

JEFFERY BLAKE JOHNSON

Original Issue Date

06/30/2010

Effective Date

03/20/2012

Expiration Date

03/31/2014

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Ever Disciplined

LastModifiedDate

05/06/2014