KEITH R HAMM OD 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

KEITH

Middle

Last Name

HAMM

Suffix

Business Name

KEITH R HAMM OD

Original Issue Date

11/19/2002

Effective Date

02/11/2004

Expiration Date

03/31/2006

City

STAUNTON

State

Zip

62088

County

MACOUPIN

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006