JON W RUSSELL OD Optometrist License verification

Business Entity

CANCELLED

License Type

Optometrist

Description

LICENSED OPTOMETRIST ANCILLARY OFFICE

License Number

047931821

License Status

CANCELLED

Business

First Name

JON

Middle

Last Name

RUSSELL

Suffix

Business Name

JON W RUSSELL OD

Original Issue Date

03/15/2006

Effective Date

01/10/2008

Expiration Date

03/31/2010

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Ever Disciplined

LastModifiedDate

05/04/2010