RANDY D FORD OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047858158

License Status

NOT RENEWED

Business

First Name

RANDY

Middle

Last Name

FORD

Suffix

Business Name

RANDY D FORD OD

Original Issue Date

12/31/1996

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

COLLINSVILLE

State

Zip

62234

County

MADISON

Ever Disciplined

LastModifiedDate

09/11/2005