REID ERIC MLSNA OD 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

REID

Middle

ERIC

Last Name

MLSNA

Suffix

Business Name

REID ERIC MLSNA OD

Original Issue Date

12/28/2005

Effective Date

01/18/2006

Expiration Date

03/31/2008

City

ROCKFORD

State

Zip

61107

County

WINNEBAGO

Specialty/Qualifier

HOSPITAL/CLINIC

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

05/02/2008