TOD M DIFFENBAUGH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****12

License Status

NOT RENEWED

Business

First Name

TOD M

Last Name

DIFFENBAUGH

Suffix

Business Name

TOD M DIFFENBAUGH OD

Original Issue Date

06/26/1996

Expiration Date

03/31/1998

City

MOLINE

State

Zip

61265

County

ROCK ISLAND

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/02/2005