KURT JACOB BENNETT OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****02

License Status

NOT RENEWED

Business

Title

First Name

KURT

Middle

JACOB

Last Name

BENNETT

Business Name

KURT JACOB BENNETT OD

Original Issue Date

10/15/2013

Effective Date

10/15/2013

Expiration Date

03/31/2014

City

GODFREY

State

Zip

62035

County

MADISON

Specialty/Qualifier

PHARM DISTRIBUTOR

Controlled Substance Schedule

III

Ever Disciplined

LastModifiedDate

05/06/2014