JEFFERY BLAKE JOHNSON Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****02

License Status

NOT RENEWED

Business

First Name

JEFFERY

Middle

BLAKE

Last Name

JOHNSON

Business Name

JEFFERY BLAKE JOHNSON

Original Issue Date

06/30/2010

Effective Date

06/30/2010

Expiration Date

03/31/2012

City

CENTRALIA

State

Zip

62801

County

MARION

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/16/2012