JONATHAN EDWARD MICETICH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****04

License Status

NOT RENEWED

Business

First Name

JONATHAN

Middle

EDWARD

Last Name

MICETICH

Suffix

Business Name

JONATHAN EDWARD MICETICH OD

Original Issue Date

09/11/1997

Effective Date

02/06/2004

Expiration Date

03/31/2006

City

KANKAKEE

State

Zip

60901

County

KANKAKEE

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/11/2006