MARIAN L LONGO 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

MARIAN

Middle

Last Name

LONGO

Suffix

Business Name

MARIAN L LONGO OD

Original Issue Date

06/28/2011

Effective Date

01/25/2012

Expiration Date

03/31/2014

City

CHICAGO

State

Zip

60616

County

COOK

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014