BLAIR BURTON LONSBERRY OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****23

License Status

NOT RENEWED

Business

First Name

BLAIR

Middle

BURTON

Last Name

LONSBERRY

Suffix

Business Name

BLAIR BURTON LONSBERRY OD

Original Issue Date

08/31/1998

Effective Date

05/18/2000

Expiration Date

03/31/2000

City

CHICAGO

State

Zip

60616

County

COOK

Specialty/Qualifier

Practitioner

Controlled Substance Schedule

Ever Disciplined

LastModifiedDate

09/11/2005