RANDY D FORD OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047778158

License Status

NOT RENEWED

Business

First Name

RANDY

Middle

Last Name

FORD

Suffix

Business Name

RANDY D FORD OD

Original Issue Date

06/20/1996

Expiration Date

03/31/1998

City

CARLINVILLE

State

Zip

62626

County

MACOUPIN

Ever Disciplined

LastModifiedDate

09/01/2005