RANDY D FORD OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047926106

License Status

CANCELLED

Business

First Name

RANDY

Middle

Last Name

FORD

Suffix

Business Name

RANDY D FORD OD

Original Issue Date

01/25/1999

Effective Date

09/22/2004

Expiration Date

03/31/2006

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

01/18/2006