MICHELLE DIANE BREHM OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****21

License Status

NOT RENEWED

Business

Title

First Name

MICHELLE

Middle

DIANE

Last Name

BREHM

Business Name

MICHELLE DIANE BREHM OD

Original Issue Date

01/27/2010

Effective Date

03/14/2012

Expiration Date

03/31/2014

City

NORTHBROOK

State

Zip

60062

County

COOK

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

05/06/2014