RONALD SCOTT BRACKENBURY OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****10

License Status

NOT RENEWED

Business

First Name

RONALD

Middle

SCOTT

Last Name

BRACKENBURY

Suffix

Business Name

RONALD SCOTT BRACKENBURY OD

Original Issue Date

03/07/2001

Effective Date

03/08/2010

Expiration Date

03/31/2012

City

PALOS PARK

State

Zip

60464

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/16/2012