KEITH A LA VALLEE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****01

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

LA VALLEE

Suffix

Business Name

KEITH A LA VALLEE OD

Original Issue Date

06/27/2000

Effective Date

04/15/2002

Expiration Date

03/31/2002

City

CHICAGO

State

Zip

60614

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

01/18/2006