KEITH A LA VALLEE OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****13

License Status

NOT RENEWED

Business

First Name

KEITH

Middle

Last Name

LA VALLEE

Suffix

Business Name

KEITH A LA VALLEE OD

Original Issue Date

03/26/2008

Effective Date

03/21/2018

Expiration Date

09/30/2020

City

CHICAGO

State

Zip

60612

County

COOK

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

01/14/2021