RUSSELL MATTHEW BRODY OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047927311

License Status

CANCELLED

Business

First Name

RUSSELL

Middle

MATTHEW

Last Name

BRODY

Suffix

Business Name

RUSSELL MATTHEW BRODY OD

Original Issue Date

08/02/2000

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

LAKE FOREST

State

Zip

60045

County

LAKE

Ever Disciplined

LastModifiedDate

05/04/2010