DAVID W JACKSON OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****18

License Status

NOT RENEWED

Business

First Name

DAVID W

Last Name

JACKSON

Suffix

Business Name

DAVID W JACKSON OD

Original Issue Date

06/17/1996

Effective Date

03/04/2014

Expiration Date

03/31/2016

City

LAKE BLUFF

State

Zip

60044

County

LAKE

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/20/2016