DANIELLE MARIE KEITH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****20

License Status

NOT RENEWED

Business

First Name

DANIELLE

Middle

MARIE

Last Name

KEITH

Suffix

Business Name

DANIELLE MARIE KEITH OD

Original Issue Date

07/06/2010

Effective Date

02/09/2012

Expiration Date

03/31/2014

City

CHAMPAIGN

State

Zip

61822

County

CHAMPAIGN

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014