JON W RUSSELL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047008174

License Status

NOT RENEWED

Business

First Name

JON

Middle

Last Name

RUSSELL

Suffix

Business Name

JON W RUSSELL OD

Original Issue Date

05/27/1994

Expiration Date

03/31/1996

City

MACHESNEY PARK

State

Zip

61115

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

09/01/2005