STEFAN MICHAEL SMITH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****11

License Status

NOT RENEWED

Business

First Name

STEFAN

Middle

MICHAEL

Last Name

SMITH

Suffix

Business Name

STEFAN MICHAEL SMITH OD

Original Issue Date

01/08/2014

Effective Date

03/01/2016

Expiration Date

03/31/2018

City

MATTOON

State

Zip

61938

County

COLES

Specialty/Qualifier

PHARM DISTRIBUTOR

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018