JACQUELYN ANN BONGARD OD Optometrist License verification

Business Entity

ACTIVE

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****06

License Status

ACTIVE

Business

Title

First Name

JACQUELYN

Middle

ANN

Last Name

BONGARD

Business Name

JACQUELYN ANN BONGARD OD

Original Issue Date

10/23/2024

Effective Date

03/15/2026

Expiration Date

03/31/2028

City

SWANSEA

State

Zip

62226

County

SAINT CLAIR

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

03/15/2026