RANDY D FORD OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047929442

License Status

NOT RENEWED

Business

First Name

RANDY

Middle

Last Name

FORD

Suffix

Business Name

RANDY D FORD OD

Original Issue Date

04/21/2003

Effective Date

06/04/2004

Expiration Date

03/31/2004

City

FAIRVIEW HEIGHTS

State

Zip

62208

County

SAINT CLAIR

Ever Disciplined

LastModifiedDate

09/11/2005