JONATHAN EDWARD MICETICH OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047018925

License Status

CANCELLED

Business

First Name

JONATHAN

Middle

EDWARD

Last Name

MICETICH

Suffix

Business Name

JONATHAN EDWARD MICETICH OD

Original Issue Date

12/24/1996

Effective Date

10/02/1997

Expiration Date

03/31/1998

City

PONTIAC

State

Zip

61764

County

LIVINGSTON

Ever Disciplined

LastModifiedDate

09/01/2005