JON W RUSSELL OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047018174

License Status

NOT RENEWED

Business

First Name

JON

Middle

Last Name

RUSSELL

Suffix

Business Name

JON W RUSSELL OD

Original Issue Date

07/03/1995

Effective Date

04/05/2004

Expiration Date

03/31/2006

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/11/2006