JONATHAN EDWARD MICETICH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047008925

License Status

NOT RENEWED

Business

First Name

JONATHAN

Middle

EDWARD

Last Name

MICETICH

Suffix

Business Name

JONATHAN EDWARD MICETICH OD

Original Issue Date

12/24/1996

Effective Date

06/12/1999

Expiration Date

03/31/1998

City

BOURBONNAIS

State

Zip

60914

County

KANKAKEE

Ever Disciplined

LastModifiedDate

09/01/2005