JEFFREY EDWIN MONTGOMERY Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****05

License Status

NOT RENEWED

Business

First Name

JEFFREY

Middle

EDWIN

Last Name

MONTGOMERY

Business Name

JEFFREY EDWIN MONTGOMERY

Original Issue Date

09/11/1997

Effective Date

02/05/2016

Expiration Date

03/31/2018

City

SPRINGFIELD

State

Zip

62704

County

SANGAMON

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018