ANSEL T JOHNSON Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****21

License Status

NOT RENEWED

Business

First Name

ANSEL T

Last Name

JOHNSON

Business Name

ANSEL T JOHNSON

Original Issue Date

07/07/1996

Effective Date

01/04/2020

Expiration Date

05/31/2022

City

BLUE ISLAND

State

Zip

60406

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

07/27/2022