STEFAN MICHAEL SMITH OD Optometrist License verification

Business Entity

NOT RENEWED

License Type

Optometrist

Description

OPTOMETRIST CONTROLLED SUBSTANCE

License Number

34*****28

License Status

NOT RENEWED

Business

First Name

STEFAN

Middle

MICHAEL

Last Name

SMITH

Suffix

Business Name

STEFAN MICHAEL SMITH OD

Original Issue Date

03/27/2014

Effective Date

03/01/2016

Expiration Date

03/31/2018

City

MARYVILLE

State

Zip

62062

County

MADISON

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

III IV V

Ever Disciplined

LastModifiedDate

06/19/2018